Provider Demographics
NPI:1508184581
Name:HOOGESTRAAT, DIANA ELIZABETH (MSW/LISW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ELIZABETH
Last Name:HOOGESTRAAT
Suffix:
Gender:F
Credentials:MSW/LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 SHARP ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1650
Mailing Address - Country:US
Mailing Address - Phone:712-527-4688
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9078
Practice Address - Country:US
Practice Address - Phone:712-256-7511
Practice Address - Fax:712-256-9766
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA013451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical