Provider Demographics
NPI:1558321406
Name:HAYES, KENNETH CHARLES (LMSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:HAYES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801
Mailing Address - Country:US
Mailing Address - Phone:641-782-8457
Mailing Address - Fax:641-782-7048
Practice Address - Street 1:1003 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801
Practice Address - Country:US
Practice Address - Phone:641-782-8457
Practice Address - Fax:641-782-7048
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14940Medicare ID - Type Unspecified