Provider Demographics
NPI:1487473401
Name:SPELLER, ATHENA R (LSW)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:R
Last Name:SPELLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 PARK CT
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1859
Mailing Address - Country:US
Mailing Address - Phone:318-753-7567
Mailing Address - Fax:
Practice Address - Street 1:3117 1ST AVE NE STE A
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4436
Practice Address - Country:US
Practice Address - Phone:319-365-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150114558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker