Healthcare Provider Details

I. General information

NPI: 1912897349
Provider Name (Legal Business Name): DEANNA M GWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E WINSLOW RD
BLOOMINGTON IN
47401-8638
US

IV. Provider business mailing address

3131 S PICCADILLY ST
BLOOMINGTON IN
47401-8691
US

V. Phone/Fax

Practice location:
  • Phone: 812-202-6001
  • Fax:
Mailing address:
  • Phone: 812-391-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: