Provider Demographics
NPI: | 1255333894 |
---|---|
Name: | REAM, LINDA DEE (LISW) |
Entity Type: | Individual |
Prefix: | |
First Name: | LINDA |
Middle Name: | DEE |
Last Name: | REAM |
Suffix: | |
Gender: | F |
Credentials: | LISW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3900 INGERSOLL AVE |
Mailing Address - Street 2: | SUITE 108 |
Mailing Address - City: | DES MOINES |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50312-3534 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 515-279-6200 |
Mailing Address - Fax: | 515-279-4528 |
Practice Address - Street 1: | 3900 INGERSOLL AVE |
Practice Address - Street 2: | SUITE 108 |
Practice Address - City: | DES MOINES |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50312-3534 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-279-6200 |
Practice Address - Fax: | 515-279-4528 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-12 |
Last Update Date: | 2017-09-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IA | 00717 | 104100000X |
IA | G132903 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | I18774 | Medicare UPIN |