Provider Demographics
NPI:1386380848
Name:BIDANIS, LATASHA KAY
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:KAY
Last Name:BIDANIS
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 1:1814 STERLING CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3044
Mailing Address - Country:US
Mailing Address - Phone:319-481-3377
Mailing Address - Fax:319-359-4125
Practice Address - Street 1:1840 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4340
Practice Address - Country:US
Practice Address - Phone:319-481-3377
Practice Address - Fax:319-359-4125
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0989731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical