Provider Demographics
NPI:1053831586
Name:DOLIESLAGER, MANDI (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:DOLIESLAGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1332
Mailing Address - Country:US
Mailing Address - Phone:712-737-2635
Mailing Address - Fax:712-737-2344
Practice Address - Street 1:400 CENTRAL AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1332
Practice Address - Country:US
Practice Address - Phone:712-737-2635
Practice Address - Fax:712-737-2344
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0864711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA086471OtherLCSW LICENSE NUMBER