| Doctor Name: | MR. JOHN TERRY FANDRICH |
| NPI Number: | 1134284185 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISW |
| License Number: | 00083 |
| Business Practice Address: | 501 Sw Ankeny Rd Ankeny, IA - 500239702 |
| Business Phone Number: | 5152892272 |
| Business Fax Number: | 5152890126 |
| Mailing Address: | 1111 University Ave, DES MOINES |
| State: | IA |
| Postal Code: | 503142329 |
| Phone Number: | 5152889181 |
| Fax Number: | 5152899109 |
| NPI Enumeration Date: | 12/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 00083 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |