Provider Demographics
NPI:1003506742
Name:DHUSE, DEENA LYNETTE (LMSW)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:LYNETTE
Last Name:DHUSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2148
Mailing Address - Country:US
Mailing Address - Phone:563-326-6431
Mailing Address - Fax:
Practice Address - Street 1:1414 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2148
Practice Address - Country:US
Practice Address - Phone:563-326-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-10-01
Deactivation Date:2024-03-28
Deactivation Code:
Reactivation Date:2025-10-01
Provider Licenses
StateLicense IDTaxonomies
IL150.105780104100000X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA420698225Medicaid