Healthcare Provider Details

I. General information

NPI: 1487168811
Provider Name (Legal Business Name): AMY RENEE TOILLION BA, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 EASTON BLVD
DES MOINES IA
50317-3214
US

IV. Provider business mailing address

3451 EASTON BLVD
DES MOINES IA
50317-3214
US

V. Phone/Fax

Practice location:
  • Phone: 515-262-0349
  • Fax: 515-266-6808
Mailing address:
  • Phone: 515-262-0349
  • Fax: 515-266-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number05047
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: