Stacey Lee Moore, BSW – Social Worker

Key facts

NPI: 1417060765
Entity type: Individual (NPI type 1)
Primary specialty: Social Worker 104100000X
License: 04904 (IA)
Practice address: 235 S Eisenhower Ave
Mason City, IA 50401-1562
Phone: (641) 424-2075
Fax: (641) 424-9555
NPI assigned: Aug 17, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Wellsource Psychologist · Mason City, IA · NPI 1992818249

NPD (past) SOCIAL WORKER

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
04904	IA	MD	Social Worker

Practice roles

Organization	Specialty	Status	New patients
Wellsource	Social Worker	Past since Jul 1, 2011	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Social Worker	104100000X	04904	IA	Yes

Addresses

Primary practice location

235 S Eisenhower Ave
Mason City, IA 50401-1562

Mailing address

235 S Eisenhower Ave
Mason City, IA 50401-1562
Phone (641) 424-2075

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417060765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 S EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504011562",
            "telephone_number": "641-424-2075",
            "fax_number": "641-424-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504011562",
            "telephone_number": "641-424-2075",
            "fax_number": "641-424-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STACEY",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "BSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IA",
            "license": "04904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason City, IA

All providers in Mason City, IA · Social Worker in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.