Provider Demographics
NPI:1124867833
Name:DENGER, MIKEELY ANN
Entity type:Individual
Prefix:
First Name:MIKEELY
Middle Name:ANN
Last Name:DENGER
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 1:1200 VALLEY WEST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1902
Mailing Address - Country:US
Mailing Address - Phone:515-619-6927
Mailing Address - Fax:515-619-6927
Practice Address - Street 1:1200 VALLEY WEST DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1902
Practice Address - Country:US
Practice Address - Phone:515-619-6927
Practice Address - Fax:515-619-6927
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health