Provider Demographics
NPI:1396912481
Name:DAUGHERTY, DUSTIN
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VALLEY WEST DR
Mailing Address - Street 2:STE 408
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1942
Mailing Address - Country:US
Mailing Address - Phone:515-868-0444
Mailing Address - Fax:515-225-7546
Practice Address - Street 1:1200 VALLEY WEST DR
Practice Address - Street 2:STE 204
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1902
Practice Address - Country:US
Practice Address - Phone:515-868-0444
Practice Address - Fax:515-225-7546
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker