Provider Demographics
NPI:1912871278
Name:HENRICHS, CALLIE JO (LMSW)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:JO
Last Name:HENRICHS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:J
Other - Last Name:GUTKNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:2240 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1575
Mailing Address - Country:US
Mailing Address - Phone:319-800-5564
Mailing Address - Fax:
Practice Address - Street 1:1220 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-9533
Practice Address - Country:US
Practice Address - Phone:319-215-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1312591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty