Provider Demographics
NPI:1912042938
Name:GERDES, BRENDA LYNN (LISW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:GERDES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11963 580TH AVE
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-8745
Mailing Address - Country:US
Mailing Address - Phone:515-979-5661
Mailing Address - Fax:
Practice Address - Street 1:914 WILLSON AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2215
Practice Address - Country:US
Practice Address - Phone:515-979-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA016641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA100059455001OtherAPS HEALTHCARE
IA9357788OtherMULTI PLAN
IA110623OtherHEALTH ALLIANCE
IA38042OtherWELLMARK BCBS
IA39883OtherWELLMARK BCBS