Provider Demographics
NPI:1558742809
Name:MENSINK, CAROL ALICE (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ALICE
Last Name:MENSINK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 SW APPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-6233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1063 14TH PL
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1245
Practice Address - Country:US
Practice Address - Phone:515-235-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA463185099Medicaid