Provider Demographics
NPI:1912390857
Name:DORRANCE, AVA (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:DORRANCE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 G AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-5053
Mailing Address - Country:US
Mailing Address - Phone:712-767-2238
Mailing Address - Fax:
Practice Address - Street 1:1000 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1454
Practice Address - Country:US
Practice Address - Phone:712-355-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical