Provider Demographics
NPI:1013580653
Name:HENRY, SUSAN (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-4428
Mailing Address - Country:US
Mailing Address - Phone:319-855-8766
Mailing Address - Fax:
Practice Address - Street 1:318 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-4428
Practice Address - Country:US
Practice Address - Phone:319-855-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0832491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical