Provider Demographics
NPI:1578542791
Name:STAPLEY, DENISE MARIE (MA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:STAPLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1205 ENGLISH LN NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7493
Mailing Address - Country:US
Mailing Address - Phone:319-202-4080
Mailing Address - Fax:
Practice Address - Street 1:1221 PARK PL NE
Practice Address - Street 2:SUITE G4
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2001
Practice Address - Country:US
Practice Address - Phone:319-202-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health