Provider Demographics
NPI:1851869770
Name:HETTINGER, TOVA RAYE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:TOVA
Middle Name:RAYE
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1610
Mailing Address - Country:US
Mailing Address - Phone:515-537-2975
Mailing Address - Fax:
Practice Address - Street 1:611 5TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1610
Practice Address - Country:US
Practice Address - Phone:515-537-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001477OtherIOWA BOARD OF PROFESSIONAL LICENSURE
IA1140012Medicaid