Provider Demographics
NPI:1154158434
Name:BAERENTZEN, DOREEN C (LISW)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:C
Last Name:BAERENTZEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E WARD ST
Mailing Address - Street 2:
Mailing Address - City:LINN GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51033-8013
Mailing Address - Country:US
Mailing Address - Phone:402-677-8225
Mailing Address - Fax:
Practice Address - Street 1:1713 MCNAUGHTON WAY
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2835
Practice Address - Country:US
Practice Address - Phone:712-584-2030
Practice Address - Fax:815-720-5080
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1282851041C0700X
IL1490115061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical