Provider Demographics
NPI:1669662854
Name:POPENHAGEN, CONNIE LYNN (MSW, LISW, ACADC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LYNN
Last Name:POPENHAGEN
Suffix:
Gender:F
Credentials:MSW, LISW, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MONTGOMERY ST
Mailing Address - Street 2:P.O. BOX 349
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2325
Mailing Address - Country:US
Mailing Address - Phone:563-382-3649
Mailing Address - Fax:563-382-8183
Practice Address - Street 1:905 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2325
Practice Address - Country:US
Practice Address - Phone:563-382-3649
Practice Address - Fax:563-382-8183
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0069281041C0700X
IA09026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)