Provider Demographics
NPI:1407864176
Name:MONSMA, REBECCA RAE (LISW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAE
Last Name:MONSMA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66054
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-256-0323
Mailing Address - Fax:515-537-1051
Practice Address - Street 1:280 S 79TH ST
Practice Address - Street 2:#1402
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8086
Practice Address - Country:US
Practice Address - Phone:515-256-0323
Practice Address - Fax:515-537-1051
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00374101YP2500X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4120550Medicaid
IA0469429Medicaid
IA4120550Medicaid