Basic Information
| Provider Information | |||||||||
| NPI: | 1407440431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | NELSON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 UNIVERSITY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152481447 | ||||||||
| FaxNumber: | 5152481440 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 LINCOLN WAY | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500148533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152320628 | ||||||||
| FaxNumber: | 5152320727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2021 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.