Healthcare Provider Details

I. General information

NPI: 1023480597
Provider Name (Legal Business Name): EMILIE SUSANNE KLEINSCHRODT M.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILIE HALBERSTADT M.S., LMHC

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 SW PARK SQUARE DR STE 206
ANKENY IA
50023-2687
US

IV. Provider business mailing address

1345 SW PARK SQUARE DR STE 206
ANKENY IA
50023-2687
US

V. Phone/Fax

Practice location:
  • Phone: 515-329-7735
  • Fax: 515-608-4580
Mailing address:
  • Phone: 515-346-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number083123
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: