Provider Demographics
NPI:1932633609
Name:ACCESS EVALUATION AND EDUCATION SERVICES, L.L.C.
Entity type:Organization
Organization Name:ACCESS EVALUATION AND EDUCATION SERVICES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BONEBRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CADC, SAP
Authorized Official - Phone:319-252-4631
Mailing Address - Street 1:3640 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5705
Mailing Address - Country:US
Mailing Address - Phone:319-252-4631
Mailing Address - Fax:181-421-2449
Practice Address - Street 1:3640 CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5705
Practice Address - Country:US
Practice Address - Phone:319-252-4631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 104100000X, 207QA0401X
IA1401251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1316467061Medicaid
IA1932633609Medicaid
IA1073291902Medicaid
IA1316001845Medicaid
IA1356788616Medicaid