Provider Demographics
NPI:1295252526
Name:MICHENER, DENNIS (CADC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:MICHENER
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5344
Mailing Address - Country:US
Mailing Address - Phone:866-801-0085
Mailing Address - Fax:515-955-7652
Practice Address - Street 1:726 S 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5344
Practice Address - Country:US
Practice Address - Phone:866-801-0085
Practice Address - Fax:515-955-7652
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)