Doctor Name: | AMANDA VANIS |
NPI Number: | 1073993986 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 077501 |
Business Practice Address: | 740 N 15th Ave Ste A Hiawatha, IA - 522332384 |
Business Phone Number: | 3193983562 |
Business Fax Number: | 3193983501 |
Mailing Address: | 520 11th St Nw, CEDAR RAPIDS |
State: | IA |
Postal Code: | 524053811 |
Phone Number: | 3193983562 |
Fax Number: | 3193983501 |
NPI Enumeration Date: | 06/05/2015 |
NPI Last Update Date: | 06/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 077501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |