Provider Demographics
NPI:1942660915
Name:WEBSTER, SHARAINE (LISW IADC)
Entity Type:Individual
Prefix:MS
First Name:SHARAINE
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LISW IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8156
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50301-8156
Mailing Address - Country:US
Mailing Address - Phone:641-233-8879
Mailing Address - Fax:515-706-3402
Practice Address - Street 1:3829 71ST ST STE B1
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3263
Practice Address - Country:US
Practice Address - Phone:515-954-7811
Practice Address - Fax:515-706-3402
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0833211041C0700X
IA13057101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA083321OtherIOWA SOCIAL WORK BOARD
IA12398268Medicaid