Provider Demographics
NPI:1073027595
Name:KENLINE, CHRISTOPHER MICHAEL (MS, IAADC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:KENLINE
Suffix:
Gender:M
Credentials:MS, IAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4203 43RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3723
Mailing Address - Country:US
Mailing Address - Phone:515-205-3233
Mailing Address - Fax:
Practice Address - Street 1:3806 EASTON BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-5730
Practice Address - Country:US
Practice Address - Phone:515-262-0349
Practice Address - Fax:515-953-6716
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)