Provider Demographics
NPI:1760776488
Name:INHELDER, RANDALL W (MSW)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:W
Last Name:INHELDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:RANDY
Other - Middle Name:W
Other - Last Name:INHELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:418 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5528
Mailing Address - Country:US
Mailing Address - Phone:641-484-9447
Mailing Address - Fax:641-484-9477
Practice Address - Street 1:1646 305TH ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9698
Practice Address - Country:US
Practice Address - Phone:641-484-9447
Practice Address - Fax:641-484-9477
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)