Provider Demographics
NPI:1366473217
Name:BANDSTRA, SHARON R (LISW MSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:BANDSTRA
Suffix:
Gender:F
Credentials:LISW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 WESTOWN PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-274-4006
Mailing Address - Fax:515-255-5697
Practice Address - Street 1:2929 WESTOWN PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-274-4006
Practice Address - Fax:515-255-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10007Medicare UPIN