Provider Demographics
NPI:1063738086
Name:CUNNINGHAM-LOGGINS, DESIREE K (LISW)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:K
Last Name:CUNNINGHAM-LOGGINS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:K
Other - Last Name:KALAINOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:100 E EUCLID AVE
Mailing Address - Street 2:SUITE 143
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4511
Mailing Address - Country:US
Mailing Address - Phone:515-256-8001
Mailing Address - Fax:515-256-8082
Practice Address - Street 1:917 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2801
Practice Address - Country:US
Practice Address - Phone:319-234-1572
Practice Address - Fax:319-234-1576
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06390104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker