Healthcare Provider Details

I. General information

NPI: 1003728296
Provider Name (Legal Business Name): DEMI JO SHETLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 CAMERON WAY STE A
NORTH LIBERTY IA
52317-4734
US

IV. Provider business mailing address

575 CAMERON WAY STE A
NORTH LIBERTY IA
52317-4734
US

V. Phone/Fax

Practice location:
  • Phone: 319-626-2558
  • Fax:
Mailing address:
  • Phone: 319-626-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number118820
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: