Provider Demographics
NPI:1235786757
Name:SHEAHAN, ALI JO
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:JO
Last Name:SHEAHAN
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 1:403 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2840
Mailing Address - Country:US
Mailing Address - Phone:319-260-2149
Mailing Address - Fax:
Practice Address - Street 1:403 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2840
Practice Address - Country:US
Practice Address - Phone:319-260-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health