Provider Demographics
NPI:1124190798
Name:KEENAN, BRENDA L (LISW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:VAN PELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:52 STURGIS CORNER DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-5617
Mailing Address - Country:US
Mailing Address - Phone:319-339-1111
Mailing Address - Fax:
Practice Address - Street 1:52 STURGIS CORNER DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5617
Practice Address - Country:US
Practice Address - Phone:319-339-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA064241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical