Provider Demographics
NPI:1821154873
Name:HENDERSON, DONNA CATE (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CATE
Last Name:HENDERSON
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:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MAUPIN
Mailing Address - State:OR
Mailing Address - Zip Code:97037-0372
Mailing Address - Country:US
Mailing Address - Phone:503-510-3789
Mailing Address - Fax:866-490-5249
Practice Address - Street 1:1101 N. HIGHWAY 197
Practice Address - Street 2:
Practice Address - City:MAUPIN
Practice Address - State:OR
Practice Address - Zip Code:97037-9703
Practice Address - Country:US
Practice Address - Phone:503-510-3789
Practice Address - Fax:866-490-5249
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082565000OtherREGENCE BCBSO PROVIDER #
VA267590OtherVALUE OPTIONS PROVIDER #
ORR158351Medicare UPIN