Provider Information for 1265425805
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
DARISSA D CHANCE LMSW
Other Names:Former Name:DARISSA D RANDOLPHSex: Female
NPI: 1265425805
Last Updated: 2023-05-09
Certification Date: 2023-05-09
Certification Date: 2023-05-09
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265425805 | ||||||||||||||||
| Enumeration Date | 2005-08-30 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 1527 ALBIA RD OTTUMWA, IA 52501-3907 United States Phone: 641-799-6528 | Fax:641-682-1924 | ||||||||||||||||
| Primary Practice Address | 1527 ALBIA RD OTTUMWA, IA 52501-3907 United States Phone: 641-682-8772 | Fax:641-682-1924 | ||||||||||||||||
| Secondary Practice Address(es) | |||||||||||||||||
| Health Information Exchange |
| ||||||||||||||||
| Other Identifiers |
| ||||||||||||||||
| Taxonomy |
|