Basic Information
| Provider Information | |||||||||
| NPI: | 1942745377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STORJOHANN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ARNP, CADC | ||||||||
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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: | 412 E CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501582947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417534021 | ||||||||
| FaxNumber: | 6418446222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2016 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | T16170 | IA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 363LP0808X | G158390 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.