Provider Demographics
NPI:1144450206
Name:LANDER, ANN MK (MSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MK
Last Name:LANDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:LA SORBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0794
Mailing Address - Country:US
Mailing Address - Phone:712-792-2991
Mailing Address - Fax:
Practice Address - Street 1:608 N COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2432
Practice Address - Country:US
Practice Address - Phone:712-792-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007357101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional