Provider Demographics
NPI:1881185403
Name:HARRIS, DANIEL KENNETH (LMSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENNETH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1905
Mailing Address - Country:US
Mailing Address - Phone:712-255-0890
Mailing Address - Fax:712-276-6040
Practice Address - Street 1:1420 W DONALD ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1624
Practice Address - Country:US
Practice Address - Phone:319-232-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker