Provider Demographics
NPI:1447796719
Name:VANOMMEREN, ANDREW L (BA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:L
Last Name:VANOMMEREN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 GRAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-2200
Mailing Address - Country:US
Mailing Address - Phone:712-262-2952
Mailing Address - Fax:712-262-9098
Practice Address - Street 1:1900 GRAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2200
Practice Address - Country:US
Practice Address - Phone:712-262-2952
Practice Address - Fax:712-262-9098
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)