Provider Demographics
NPI:1083405153
Name:DEMOSS, ZELDA ISIS
Entity type:Individual
Prefix:
First Name:ZELDA
Middle Name:ISIS
Last Name:DEMOSS
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 1:591 NE VENTURE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9824
Mailing Address - Country:US
Mailing Address - Phone:712-292-3751
Mailing Address - Fax:
Practice Address - Street 1:7755 OFFICE PLAZA DR N STE 105
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2339
Practice Address - Country:US
Practice Address - Phone:515-505-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician