Provider Demographics
NPI:1326660903
Name:ANTONIA L. VALADEZ, LISW, LLC
Entity Type:Organization
Organization Name:ANTONIA L. VALADEZ, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-344-4483
Mailing Address - Street 1:4608 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-4157
Mailing Address - Country:US
Mailing Address - Phone:515-344-4483
Mailing Address - Fax:515-724-7991
Practice Address - Street 1:4685 MERLE HAY RD STE 108
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1982
Practice Address - Country:US
Practice Address - Phone:515-344-4483
Practice Address - Fax:515-724-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)