Provider Demographics
NPI:1659787315
Name:MILLSAP, MIKEL (MSW)
Entity Type:Individual
Prefix:
First Name:MIKEL
Middle Name:
Last Name:MILLSAP
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:ONSLOW
Mailing Address - State:IA
Mailing Address - Zip Code:52321-0001
Mailing Address - Country:US
Mailing Address - Phone:563-485-5070
Mailing Address - Fax:
Practice Address - Street 1:304 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ONSLOW
Practice Address - State:IA
Practice Address - Zip Code:52321-7585
Practice Address - Country:US
Practice Address - Phone:563-485-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006898104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker