Provider Demographics
NPI:1861767022
Name:OMELIA, ANNIKA KRISTINE (LISW)
Entity type:Individual
Prefix:MRS
First Name:ANNIKA
Middle Name:KRISTINE
Last Name:OMELIA
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 1:1510 E RUSHOLME ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2463
Mailing Address - Country:US
Mailing Address - Phone:563-359-6633
Mailing Address - Fax:563-359-5261
Practice Address - Street 1:1510 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2463
Practice Address - Country:US
Practice Address - Phone:563-359-6633
Practice Address - Fax:563-359-5261
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0074391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical