Provider Demographics
NPI:1033496450
Name:NESSA, STACIE RENAE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:RENAE
Last Name:NESSA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:RENAE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 SE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5324
Mailing Address - Country:US
Mailing Address - Phone:515-282-9377
Mailing Address - Fax:515-282-6162
Practice Address - Street 1:918 SE 11TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5324
Practice Address - Country:US
Practice Address - Phone:515-282-9377
Practice Address - Fax:515-282-6162
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03708104100000X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool