Healthcare Provider Details

I. General information

NPI: 1588504898
Provider Name (Legal Business Name): KIRK L STORM CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 11TH ST
DES MOINES IA
50313-3322
US

IV. Provider business mailing address

4033 11TH ST
DES MOINES IA
50313-3322
US

V. Phone/Fax

Practice location:
  • Phone: 515-710-7170
  • Fax:
Mailing address:
  • Phone: 515-710-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25011
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: