Provider Demographics
NPI:1376630277
Name:MARANDOLA, DENISE ACKER (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ACKER
Last Name:MARANDOLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 PIERCE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3871
Mailing Address - Country:US
Mailing Address - Phone:712-255-8323
Mailing Address - Fax:712-255-8287
Practice Address - Street 1:2212 PIERCE ST
Practice Address - Street 2:STE. 100
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3871
Practice Address - Country:US
Practice Address - Phone:712-255-8323
Practice Address - Fax:712-255-8287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1152322Medicaid
IA44802Medicare ID - Type Unspecified