Provider Demographics
NPI:1073289062
Name:DAEHLER, CATELYNN JANE
Entity Type:Individual
Prefix:
First Name:CATELYNN
Middle Name:JANE
Last Name:DAEHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2105
Mailing Address - Country:US
Mailing Address - Phone:309-797-7700
Mailing Address - Fax:309-797-2386
Practice Address - Street 1:2195 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2705
Practice Address - Country:US
Practice Address - Phone:309-797-7700
Practice Address - Fax:563-324-2437
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108656104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker