Provider Demographics
NPI:1154633741
Name:GILLILAND-MINARD, DEVON (LMSW)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:GILLILAND-MINARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VALLEY WEST DR STE 304-10
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1903
Mailing Address - Country:US
Mailing Address - Phone:515-309-2113
Mailing Address - Fax:515-864-0537
Practice Address - Street 1:1200 VALLEY WEST DR STE 304-10
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1903
Practice Address - Country:US
Practice Address - Phone:515-309-2113
Practice Address - Fax:515-864-0537
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007523104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469676Medicaid
IA1001123Medicaid