Provider Demographics
NPI:1770592982
Name:DORSETT, MARY ANN (LISW)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:DORSETT
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:PO BOX 66054
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-256-0323
Mailing Address - Fax:515-256-0152
Practice Address - Street 1:7725 WISTFUL VISTA DR
Practice Address - Street 2:# 703
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8032
Practice Address - Country:US
Practice Address - Phone:515-256-0323
Practice Address - Fax:515-537-1051
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14593Medicare ID - Type Unspecified