Provider Demographics
NPI:1912059163
Name:HIRT, DONNA KARLENE (LCSW, CADC III)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KARLENE
Last Name:HIRT
Suffix:
Gender:F
Credentials:LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4265
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-365-3038
Mailing Address - Fax:
Practice Address - Street 1:2985 RIVER RD S
Practice Address - Street 2:ST. 5
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6651
Practice Address - Country:US
Practice Address - Phone:503-365-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR900103101YA0400X
OR32691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3269OtherLICENSE #
OR900103OtherCERTIFICATION #
OR117738Medicare PIN