Healthcare Provider Details

I. General information

NPI: 1720602279
Provider Name (Legal Business Name): MS. VANESSA MARIE ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

IV. Provider business mailing address

1012 POLK BLVD
DES MOINES IA
50311-3333
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-2200
  • Fax: 515-282-5744
Mailing address:
  • Phone: 515-991-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100326
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12918
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number206957
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: