MEDICARE: JAMIE MARIE AVENDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13032	IA
2	101YM0800X	Mental Health Counselor	074911	IA

General Provider Information

NPI Number	:	1497156681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MARIE AVENDT

Provider Business Mailing Address
First Line	:	950 OFFICE PARK RD STE 235
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2121
Country	:	US
Telephone Number	:	515-419-1578
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 OFFICE PARK RD STE 235
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-2121
Country	:	US
Telephone Number	:	515-419-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	03/03/2026

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