Provider Demographics
NPI:1073993986
Name:VANIS, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 5TH AVE SE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2416
Mailing Address - Country:US
Mailing Address - Phone:319-286-4545
Mailing Address - Fax:319-368-3358
Practice Address - Street 1:1030 5TH AVE SE
Practice Address - Street 2:SUITE 3000
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2416
Practice Address - Country:US
Practice Address - Phone:319-286-4545
Practice Address - Fax:319-368-3358
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074575Medicaid