Provider Demographics
NPI:1861839631
Name:ANDERSEN, VANESSA MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MARIE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:MARIE
Other - Last Name:SHILENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1220 NE STATION XING STE 114
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-8013
Mailing Address - Country:US
Mailing Address - Phone:153-806-5165
Mailing Address - Fax:
Practice Address - Street 1:1220 NE STATION XING STE 114
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-8013
Practice Address - Country:US
Practice Address - Phone:515-380-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0082071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical