Provider Demographics
NPI:1740798420
Name:LANSER, JODYIE KATHERINE (LMHC)
Entity Type:Individual
Prefix:
First Name:JODYIE
Middle Name:KATHERINE
Last Name:LANSER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3400
Mailing Address - Country:US
Mailing Address - Phone:515-225-2500
Mailing Address - Fax:
Practice Address - Street 1:3812 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3400
Practice Address - Country:US
Practice Address - Phone:515-225-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA208012262OtherTAX ID #
IA0748988Medicaid