Provider Demographics
NPI:1417199878
Name:WARREN, KATHLEEN (LISW, CADC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LISW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1109
Mailing Address - Country:US
Mailing Address - Phone:515-248-1484
Mailing Address - Fax:515-248-1410
Practice Address - Street 1:1200 UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2355
Practice Address - Country:US
Practice Address - Phone:515-248-1447
Practice Address - Fax:515-248-1440
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06150101YA0400X
IA0079971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)