Healthcare Provider Details

I. General information

NPI: 1821154873
Provider Name (Legal Business Name): DONNA CATE HENDERSON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N. HIGHWAY 197
MAUPIN OR
97037-9703
US

IV. Provider business mailing address

PO BOX 372
MAUPIN OR
97037-0372
US

V. Phone/Fax

Practice location:
  • Phone: 503-510-3789
  • Fax: 866-490-5249
Mailing address:
  • Phone: 503-510-3789
  • Fax: 866-490-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0995
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier082565000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerREGENCE BCBSO PROVIDER #
# 2
Identifier267590
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerVALUE OPTIONS PROVIDER #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: