Provider Demographics
NPI:1740792266
Name:DONAHUE, KATHERINE ANN (LISW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LONGFELLOW PL
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6267
Mailing Address - Country:US
Mailing Address - Phone:319-512-8719
Mailing Address - Fax:
Practice Address - Street 1:960 LONGFELLOW PL
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6267
Practice Address - Country:US
Practice Address - Phone:319-512-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06776OtherBUREAU OF PROFESSIONAL LICENSURE, IOWA BOARD OF SOCIAL WORK
IA886587375OtherNASW NATIONAL ASSOCIATION OF SOCIAL WORKERS, IOWA CHAPTER