MRS. BRENNA A. KOEDAM (NPI# 1437409281) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437409281 |
| Entity Type | Individual |
| Full Name | MRS. BRENNA A. KOEDAM |
| Credential | LMHC, IADC |
| Practice Address |
201 E 11th St Spencer IA 51301-4436 |
| Practice Telephone | 8002425101 |
| Mailing Telephone | 8002425101 |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2012-09-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
05041 | IA | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
001530 | IA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0011650 | 05 |
| Street Address |
201 E 11TH ST |
| City | SPENCER |
| State | IA |
| Zip Code | 51301-4436 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689669459 | Northwest Iowa Mental Health Center | Clinic/Center | 201 E 11th St, Spencer, IA 51301-4436 | 2005-09-16 |
| 1760096184 | Ema Basie Enriquez | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2020-09-02 |
| 1770120917 | Kimberly Sue Silberstein | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2019-12-06 |
| 1417504218 | Angus C Raymond | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2019-08-26 |
| 1912551201 | Joan Wagner | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2019-07-25 |
| 1801362884 | Michael Raymond Popp | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2018-10-17 |
| 1346732385 | Jennifer Den Boer | Social Worker | 201 E 11th St, Spencer, IA 51301-4436 | 2018-06-05 |
| 1396273512 | Jackie Tjaden | Counselor | 201 E 11th St, Spencer, IA 51301-4436 | 2017-06-01 |
| 1811424096 | Kelly Sinnema | Counselor | 201 E 11th St, Spencer, IA 51301-4436 | 2017-05-18 |
| 1144779216 | Melissa Eve Mugge Anderson | Counselor | 201 E 11th St, Spencer, IA 51301-4436 | 2016-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508331877 | Angie Marie Wigen | Occupational Therapy Assistant | 1202 11 Th Ave Se, Spencer, IA 51301 | 2018-10-12 |
| 1184040511 | Leisha Fischer | Nurse Practitioner | 116 East 7th Street, Suite 2, Spencer, IA 51301 | 2014-03-10 |
| 1427482199 | Mark Alan De Ruyter | Social Worker | 116 E. 11th St., Spencer, IA 51301 | 2013-08-29 |
| 1467894873 | Daniel Wesley Abbott | Pathology | 116 E 11th St Ste 204, Spencer, IA 51301 | 2013-07-26 |
| 1730437542 | Spencer Convenient Healthcare LLC | Clinic/Center | 116 E. 7th Street, Suite 2, Spencer, IA 51301 | 2012-08-28 |
| 1114065109 | David W Lawrence | Audiologist-Hearing Aid Fitter | 920 North Grand Ave., Spencer, IA 51301 | 2007-02-02 |
| 1548328925 | Burns Chiropractic Center P C | Chiropractor | 1210 West 18th St, Spencer, IA 51301 | 2006-12-05 |
| 1073692661 | Gary Vanhofwegen | Dentist | 18 West 4th St, Spencer, IA 51301 | 2006-11-03 |
| 1952494114 | Medicap Pharmacy | Pharmacy | 829 Grand Ave N, Spencer, IA 51301 | 2006-10-02 |
| 1326131012 | Douglas J Schwartz | Chiropractor | 1204 West 18th St, Spencer, IA 51301 | 2006-10-02 |
| Find all providers in zip 51301 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669835732 | Joann Deyoung | Counselor | 1900 Grand Ave N Ste A, Spencer, IA 51301-2200 | 2016-04-05 |
| 1043649270 | Frank Cecil Calvin | Counselor | 8617 Honeylocust Dr, Spencer, OK 73084-2115 | 2013-11-07 |
| 1497039135 | Charles Lee Tucker I | Counselor | 12925 Ne 59th St, Spencer, OK 73084-8605 | 2011-09-29 |
| 1417254681 | Comelia Jackson | Counselor | 8616 Ne 35th St, Spencer, OK 73084-3206 | 2011-02-23 |
| 1063731149 | Charzina Fields | Counselor | 4817 Shady Nook Way, Spencer, OK 73084-2550 | 2010-05-27 |
| 1760096184 | Ema Basie Enriquez | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2020-09-02 |
| 1770120917 | Kimberly Sue Silberstein | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2019-12-06 |
| 1417504218 | Angus C Raymond | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2019-08-26 |
| 1912551201 | Joan Wagner | Counselor | 201 E 11th St, Spencer, IA 51301-4460 | 2019-07-25 |
| 1982178034 | Sage Johnson | Counselor | 1900 Grand Ave N, Ste A, Spencer, IA 51301-2200 | 2019-01-11 |
| Find all providers in SPENCER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.