MEDICARE: DEANNA SUBLETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180011937	IL
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1598436271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA SUBLETTE

Provider Business Mailing Address
First Line	:	1601 OLD SOUTH RIVER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-4120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 YORK ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-3963
Country	:	US
Telephone Number	:	217-222-6277
Fax Number	:	217-214-5450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	05/25/2026

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Directions to “ DEANNA SUBLETTE ” Practice Location

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