Provider Demographics
NPI:1487833521
Name:HENRY, DONALD KENTON (BSW SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:KENTON
Last Name:HENRY
Suffix:
Gender:M
Credentials:BSW SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872023
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2023
Mailing Address - Country:US
Mailing Address - Phone:907-373-4692
Mailing Address - Fax:
Practice Address - Street 1:5325 ASPEN STREET
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-5325
Practice Address - Country:US
Practice Address - Phone:907-373-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK290674171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator