Provider Demographics
NPI:1720475312
Name:DENNERLEIN, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DENNERLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-381 KEALAKEHE PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2705
Mailing Address - Country:US
Mailing Address - Phone:209-261-0166
Mailing Address - Fax:
Practice Address - Street 1:74-381 KEALAKEHE PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2705
Practice Address - Country:US
Practice Address - Phone:209-261-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36951041C0700X
CA659111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical