Healthcare Provider Details

I. General information

NPI: 1912215666
Provider Name (Legal Business Name): JESSICA PAOLA PFEIFFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 12/04/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 ASHMORE DR
AMES IA
50014-7805
US

IV. Provider business mailing address

2028 ASHMORE DR
AMES IA
50014-7805
US

V. Phone/Fax

Practice location:
  • Phone: 515-460-4446
  • Fax:
Mailing address:
  • Phone: 515-460-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number129562
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW00001400
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129225
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: