Provider Demographics
NPI:1679133169
Name:WEISS, DELPHINE LINDA (LISW)
Entity type:Individual
Prefix:
First Name:DELPHINE
Middle Name:LINDA
Last Name:WEISS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12051 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8226
Mailing Address - Country:US
Mailing Address - Phone:515-520-9378
Mailing Address - Fax:
Practice Address - Street 1:2425 N ANKENY BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4722
Practice Address - Country:US
Practice Address - Phone:515-520-9378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095369104100000X, 1041C0700X
MO20240272941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker