Provider Demographics
NPI:1942919063
Name:NELSON, ANDREA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1821
Mailing Address - Country:US
Mailing Address - Phone:206-778-3969
Mailing Address - Fax:
Practice Address - Street 1:1605 N ANKENY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4163
Practice Address - Country:US
Practice Address - Phone:515-619-6855
Practice Address - Fax:515-373-3270
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107268101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA107268OtherIOWA DEPT. OF PUBLIC HEALTH / BOARD OF SOCIAL WORK