Healthcare Provider Details

I. General information

NPI: 1174221683
Provider Name (Legal Business Name): MR. ANDREW JOSEPH HOPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N ANKENY BLVD
ANKENY IA
50023-4003
US

IV. Provider business mailing address

1105 N ANKENY BLVD STE 100
ANKENY IA
50023-4003
US

V. Phone/Fax

Practice location:
  • Phone: 515-255-8399
  • Fax:
Mailing address:
  • Phone: 515-255-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23005
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number123976
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: