Provider Demographics
NPI:1831248764
Name:ANDERSON, DEBORAH LEA (ACADC, LMSW, SAP, RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ACADC, LMSW, SAP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 650TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-8872
Mailing Address - Country:US
Mailing Address - Phone:641-344-1384
Mailing Address - Fax:
Practice Address - Street 1:221 E STATE ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1813
Practice Address - Country:US
Practice Address - Phone:641-856-2775
Practice Address - Fax:641-856-2779
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA86036101YA0400X
IA11002101YA0400X
IA036441041C0700X
IA064787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA0105OtherJOHN DEERE HEALTHCARE