Healthcare Provider Details

I. General information

NPI: 1568092195
Provider Name (Legal Business Name): ELEVATE THERAPY & ASSESSMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 10TH ST
MILFORD IA
51351-1530
US

IV. Provider business mailing address

PO BOX 132
MILFORD IA
51351-0132
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-6200
  • Fax: 712-338-6205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. NATALIE JO SANDBULTE
Title or Position: CO-OWNER
Credential: PSY.D.
Phone: 712-240-2785