| Ican Program | |
|
1007 S Jefferson Way Indianola IA 50125-3221 | |
| (515) 962-9058 | |
| Not Available |
| Full Name | Ican Program |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1007 S Jefferson Way, Indianola, Iowa |
| Authorized Official Name and Position | Winifred Jeanette Hall (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 5159629058 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ican Program 2812 Cottage Grove Ave Des Moines IA 50311-4010 Ph: (515) 274-6351 | Ican Program 1007 S Jefferson Way Indianola IA 50125-3221 Ph: (515) 962-9058 |
| NPI Number | 1689879678 |
|---|---|
| Provider Enumeration Date | 06/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689879678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 00743 (Iowa) | Primary |
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