Provider Demographics
NPI:1568911386
Name:GIDEON, JANET (LMSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GIDEON
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 1:4108 WAKONDA PKWY
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-3353
Mailing Address - Country:US
Mailing Address - Phone:515-975-0769
Mailing Address - Fax:
Practice Address - Street 1:3812 INGERSOLL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3400
Practice Address - Country:US
Practice Address - Phone:515-255-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0814791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical