Healthcare Provider Details

I. General information

NPI: 1841113909
Provider Name (Legal Business Name): ANNIKA BOONSTRA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 5TH AVE
DES MOINES IA
50309-1315
US

IV. Provider business mailing address

808 5TH AVE
DES MOINES IA
50309-1315
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-2267
  • Fax: 515-244-1922
Mailing address:
  • Phone: 515-244-2267
  • Fax: 515-244-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138925
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: