Provider Demographics
NPI:1730345281
Name:ROSS, ANNIKA FAITH (LISW)
Entity type:Individual
Prefix:MRS
First Name:ANNIKA
Middle Name:FAITH
Last Name:ROSS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 5TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-321-5707
Mailing Address - Fax:866-468-4419
Practice Address - Street 1:1101 5TH ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-321-5707
Practice Address - Fax:866-468-4419
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006903101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health