Healthcare Provider Details

I. General information

NPI: 1932633609
Provider Name (Legal Business Name): ACCESS EVALUATION AND EDUCATION SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CANTERBURY CT
WATERLOO IA
50702-5705
US

IV. Provider business mailing address

3640 CANTERBURY CT
WATERLOO IA
50702-5705
US

V. Phone/Fax

Practice location:
  • Phone: 319-252-4631
  • Fax:
Mailing address:
  • Phone: 319-252-4631
  • Fax: 181-421-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1401
License Number StateIA

VIII. Authorized Official

Name: AMY RENEE BONEBRAKE
Title or Position: OWNER/ DIRECTOR
Credential: MSW, CADC, SAP
Phone: 319-252-4631