Provider Demographics
NPI:1972153278
Name:BANDILLA, ERIKA (LISW)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BANDILLA
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 1:128 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5139
Mailing Address - Country:US
Mailing Address - Phone:319-988-1800
Mailing Address - Fax:319-553-6055
Practice Address - Street 1:128 PLAZA CIR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5139
Practice Address - Country:US
Practice Address - Phone:319-988-1800
Practice Address - Fax:319-553-6055
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0868531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074435Medicaid