Basic Information
Provider Information | |||||||||
NPI: | 1942805320 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAPMAN | ||||||||
FirstName: | MICHAELA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6200 AURORA AVE STE 401E | ||||||||
Address2: |   | ||||||||
City: | URBANDALE | ||||||||
State: | IA | ||||||||
PostalCode: | 503222866 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5153310303 | ||||||||
FaxNumber: | 5153319086 | ||||||||
Practice Location | |||||||||
Address1: | 2611 WASHINGTON ST | ||||||||
Address2: |   | ||||||||
City: | PELLA | ||||||||
State: | IA | ||||||||
PostalCode: | 502197924 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6416289599 | ||||||||
FaxNumber: | 6416211493 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/02/2020 | ||||||||
LastUpdateDate: | 12/02/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/02/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X |   | IA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | 101610 | IA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.