Healthcare Provider Details

I. General information

NPI: 1548176282
Provider Name (Legal Business Name): FAMILYA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 SE ALICES RD # 1059
WAUKEE IA
50263-9646
US

IV. Provider business mailing address

731 SE ALICES RD # 1059
WAUKEE IA
50263-9646
US

V. Phone/Fax

Practice location:
  • Phone: 515-423-0345
  • Fax:
Mailing address:
  • Phone: 515-423-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NADYNE BERNADETTE MONTIEL DE GAGNIER
Title or Position: OWNER AND PROPRIETOR
Credential: LCSW
Phone: 515-423-0345