Provider Demographics
NPI:1437411402
Name:WRIGHTSMAN, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WRIGHTSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 CUMMING AVE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:IA
Mailing Address - Zip Code:50061-9337
Mailing Address - Country:US
Mailing Address - Phone:515-657-1416
Mailing Address - Fax:
Practice Address - Street 1:7105 NW 70TH AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1824
Practice Address - Country:US
Practice Address - Phone:515-334-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008031104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker