Healthcare Provider Details

I. General information

NPI: 1043981632
Provider Name (Legal Business Name): SHANNON LENTFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON VANEE

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 HOME PLZ STE 301
WATERLOO IA
50701-4822
US

IV. Provider business mailing address

PO BOX 2758
WATERLOO IA
50704-2758
US

V. Phone/Fax

Practice location:
  • Phone: 319-299-2864
  • Fax:
Mailing address:
  • Phone: 319-235-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099899
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: