Provider Demographics
NPI:1679133169
Name:WEISS, DELPHINE LINDA
Entity Type:Individual
Prefix:
First Name:DELPHINE
Middle Name:LINDA
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BILLY SUNDAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8048
Mailing Address - Country:US
Mailing Address - Phone:515-337-1764
Mailing Address - Fax:515-337-0480
Practice Address - Street 1:614 BILLY SUNDAY RD STE 100
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8048
Practice Address - Country:US
Practice Address - Phone:515-337-1764
Practice Address - Fax:515-337-0480
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095369104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker