Provider Demographics
NPI:1972827376
Name:HENDRICKS, DONALD REED (MSW)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:REED
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:D.
Other - Middle Name:REED
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:232 EAST 5TH SOUTH
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440
Mailing Address - Country:US
Mailing Address - Phone:208-206-2332
Mailing Address - Fax:
Practice Address - Street 1:232 EAST 5TH SOUTH
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440
Practice Address - Country:US
Practice Address - Phone:208-206-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-6321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical