Provider Demographics
NPI:1992178099
Name:SHORT, ANNA (CADC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S GEAR AVE
Mailing Address - Street 2:MERCY PLAZA STE 251
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-768-3700
Mailing Address - Fax:319-768-3712
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:MERCY PLAZA STE 251
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-768-3700
Practice Address - Fax:319-768-3712
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05110104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker