Provider Demographics
NPI:1568676237
Name:POLAND, DOUGLAS ELTON (LMSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ELTON
Last Name:POLAND
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1071
Mailing Address - Country:US
Mailing Address - Phone:712-542-2883
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1165
Practice Address - Country:US
Practice Address - Phone:712-542-2388
Practice Address - Fax:712-542-2984
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01992104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker