Provider Demographics
NPI:1851678296
Name:DONNA HENDERSON, LCSW
Entity Type:Organization
Organization Name:DONNA HENDERSON, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-838-6144
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:503-838-6144
Mailing Address - Fax:866-490-5249
Practice Address - Street 1:615 TIMBER LN
Practice Address - Street 2:
Practice Address - City:MAUPIN
Practice Address - State:OR
Practice Address - Zip Code:97037-7148
Practice Address - Country:US
Practice Address - Phone:503-838-6144
Practice Address - Fax:866-490-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR158351Medicare PIN