Healthcare Provider Details

I. General information

NPI: 1396663035
Provider Name (Legal Business Name): GABRIELLE COLLINS LMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CAMERON WAY UNIT 2
NORTH LIBERTY IA
52317-4901
US

IV. Provider business mailing address

555 CAMERON WAY UNIT 2
NORTH LIBERTY IA
52317-4901
US

V. Phone/Fax

Practice location:
  • Phone: 319-804-9312
  • Fax: 319-449-3845
Mailing address:
  • Phone: 319-804-9312
  • Fax: 319-449-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number137713
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: