Provider Demographics
NPI:1134472251
Name:HINDERAKER, DIANE REBECCA (BA)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:REBECCA
Last Name:HINDERAKER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BURNETT AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6128
Mailing Address - Country:US
Mailing Address - Phone:515-233-5048
Mailing Address - Fax:515-663-4909
Practice Address - Street 1:712 BURNETT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6128
Practice Address - Country:US
Practice Address - Phone:515-233-5048
Practice Address - Fax:515-663-4909
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)