Provider Demographics
NPI:1154848125
Name:SHANDRI, MARIAH BLISS (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:BLISS
Last Name:SHANDRI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:BLISS
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:514 NW BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2272
Mailing Address - Country:US
Mailing Address - Phone:563-599-2588
Mailing Address - Fax:
Practice Address - Street 1:514 NW BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2272
Practice Address - Country:US
Practice Address - Phone:563-599-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker