Provider Demographics
NPI:1417601733
Name:GRAJEDA, DEBRENEE D (LSW)
Entity Type:Individual
Prefix:
First Name:DEBRENEE
Middle Name:D
Last Name:GRAJEDA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2501
Mailing Address - Country:US
Mailing Address - Phone:515-237-5092
Mailing Address - Fax:515-237-5099
Practice Address - Street 1:1215 N BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1548
Practice Address - Country:US
Practice Address - Phone:712-328-3086
Practice Address - Fax:712-328-2059
Is Sole Proprietor?:No
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health