1063738086 NPI number — DESIREE K CUNNINGHAM-LOGGINS LISW

Table of content: DESIREE K CUNNINGHAM-LOGGINS LISW (NPI 1063738086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063738086 NPI number — DESIREE K CUNNINGHAM-LOGGINS LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM-LOGGINS
Provider First Name:
DESIREE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KALAINOFF
Provider Other First Name:
DESIREE
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063738086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E EUCLID AVE
Provider Second Line Business Mailing Address:
SUITE 143
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50313-4511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-256-8001
Provider Business Mailing Address Fax Number:
515-256-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50702-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-234-1572
Provider Business Practice Location Address Fax Number:
319-234-1576
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  06390 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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