Provider Demographics
NPI:1841298056
Name:DELAPP, KATHRYN RENEE (LCSW, CMSW, JD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENEE
Last Name:DELAPP
Suffix:
Gender:F
Credentials:LCSW, CMSW, JD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:DELAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, CMSW, JD
Mailing Address - Street 1:1218 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-4722
Mailing Address - Country:US
Mailing Address - Phone:865-406-8462
Mailing Address - Fax:501-404-9049
Practice Address - Street 1:1218 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-4722
Practice Address - Country:US
Practice Address - Phone:865-406-8462
Practice Address - Fax:501-404-9049
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
AR8132-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521124Medicaid