Provider Demographics
NPI:1376060053
Name:STIMSON, MIKKI (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MIKKI
Middle Name:
Last Name:STIMSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MIKKI
Other - Middle Name:
Other - Last Name:HAMDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:15125 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4530
Mailing Address - Country:US
Mailing Address - Phone:515-777-0646
Mailing Address - Fax:
Practice Address - Street 1:15125 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4530
Practice Address - Country:US
Practice Address - Phone:515-777-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker