Provider Demographics
NPI:1639825474
Name:THELANDER, DENISE LEE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LEE
Last Name:THELANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:LEE
Other - Last Name:SHERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1905
Mailing Address - Country:US
Mailing Address - Phone:712-255-0890
Mailing Address - Fax:712-276-6040
Practice Address - Street 1:1115 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1905
Practice Address - Country:US
Practice Address - Phone:319-290-7546
Practice Address - Fax:712-276-4060
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1107451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical