Provider Demographics
NPI:1891209656
Name:HUNTER-MANN, ELIZABETH (CADC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HUNTER-MANN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 EASTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-3214
Mailing Address - Country:US
Mailing Address - Phone:515-262-0349
Mailing Address - Fax:
Practice Address - Street 1:3806 EASTON BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-5730
Practice Address - Country:US
Practice Address - Phone:515-262-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)