Individual provider Active NPI

Alyssa Vibbard, LISW

  • Clinical Social Worker
  • Ankeny, IA
National Provider Identifier
1104264530
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
087466 Issued in IA
Practice address
1105 N Ankeny Blvd Ste 100
Ankeny, IA 50023-4003
Phone
(515) 255-8399
NPI assigned
Jun 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 087466 IA Primary

Addresses

Primary practice location

1105 N Ankeny Blvd Ste 100
Ankeny, IA 50023-4003

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 628-9566

Other names 1

  • Alyssa Pfantz Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address avibbard@lifeworksdm.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250108004006 IA Practitioner - Clinical Social Worker 4486182193 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1105 N Ankeny Blvd
Suite 100
Ankeny, IA 50023-4003
Phone (515) 255-8399

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
087466IAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatric Associates of Iowa, PC CurrentSince Nov 21, 2024 Accepting new patients
Psychiatric Associates of Iowa, PC Current Accepting new patients

Locations

1105 N Ankeny Blvd
Ankeny, IA 50023
Phone (515) 255-8399

1105 N Ankeny Blvd
Ste 100
Ankeny, IA 50023
Phone (515) 255-8399

1290 Jordan St
North Liberty, IA 52317
Phone (319) 356-6352

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1104264530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 N ANKENY BLVD STE 100",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500234003",
            "telephone_number": "515-255-8399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIBBARD",
        "first_name": "ALYSSA",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-07",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "087466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "avibbard@lifeworksdm.com",
            "affiliation": "N",
            "address_1": "1105 N Ankeny Blvd Ste 100",
            "city": "Ankeny",
            "state": "IA",
            "country_code": "US",
            "postal_code": "500234003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "PFANTZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.