Provider Demographics
NPI:1760492292
Name:KAIN, PENNY (LCSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:KAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 EASTERN AVE
Mailing Address - Street 2:BLDG G
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2012
Mailing Address - Country:US
Mailing Address - Phone:309-788-9581
Mailing Address - Fax:309-788-9608
Practice Address - Street 1:4703 44TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7189
Practice Address - Country:US
Practice Address - Phone:309-788-9581
Practice Address - Fax:309-788-9608
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490108301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical