Provider Demographics
NPI:1467703611
Name:RUSSELL, SHEILA LEAH (LISW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:LEAH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LISW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 WOODLAND AVE STE 620
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1937
Mailing Address - Country:US
Mailing Address - Phone:515-868-4815
Mailing Address - Fax:
Practice Address - Street 1:3737 WOODLAND AVE STE 620
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1937
Practice Address - Country:US
Practice Address - Phone:515-868-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007903104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker