Provider Demographics
NPI:1104058270
Name:VANOUS, JILL A (LISW)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:A
Last Name:VANOUS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5400 KIRKWOOD BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5216
Mailing Address - Country:US
Mailing Address - Phone:319-364-0259
Mailing Address - Fax:866-290-5565
Practice Address - Street 1:317 7TH AVE SE
Practice Address - Street 2:SUITE 304
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2007
Practice Address - Country:US
Practice Address - Phone:319-784-2740
Practice Address - Fax:866-266-5895
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical