Healthcare Provider Details

I. General information

NPI: 1497156681
Provider Name (Legal Business Name): JAMIE MARIE AVENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 NW 62ND AVE # 159
JOHNSTON IA
50131-1715
US

IV. Provider business mailing address

9901 NW 62ND AVE # 159
JOHNSTON IA
50131-1715
US

V. Phone/Fax

Practice location:
  • Phone: 515-679-5969
  • Fax:
Mailing address:
  • Phone: 515-679-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13032
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number074911
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: