Healthcare Provider Details

I. General information

NPI: 1790912517
Provider Name (Legal Business Name): VICKI AILEY-ROBERSON LMHC, ACADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 SE MILL POND CT
ANKENY IA
50021-6544
US

IV. Provider business mailing address

1850 SW PLAZA SHOPS LN STE D
ANKENY IA
50023-7168
US

V. Phone/Fax

Practice location:
  • Phone: 515-508-1150
  • Fax:
Mailing address:
  • Phone: 515-508-1150
  • Fax: 866-473-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number96051
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00918
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: