Provider Demographics
NPI:1932816071
Name:ANDERSON, STACIE L
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 LANDAU ST
Mailing Address - Street 2:
Mailing Address - City:ROBINS
Mailing Address - State:IA
Mailing Address - Zip Code:52328-9400
Mailing Address - Country:US
Mailing Address - Phone:319-640-6505
Mailing Address - Fax:
Practice Address - Street 1:3412 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5529
Practice Address - Country:US
Practice Address - Phone:319-382-8660
Practice Address - Fax:319-382-8693
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health