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General NPI Number Information
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NPI Number | 1083453757
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Entity Type | Individual
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Provider Name | VICTORIA ANNE DENNIS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 409 B AVE
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City | KALONA
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State | IA
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Zip | 52247-7719
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Country | US
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Telephone | 641-777-2774
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Fax |
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Provider Business Mailing Address
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Address Line | 555 HIGHWAY 965 S APT 3
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-9182
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Country | US
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Telephone | 319-621-9570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 125916
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License Number State | IA
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