Healthcare Provider Details

I. General information

NPI: 1215371018
Provider Name (Legal Business Name): GINA ELIZABETH DEATON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

1700 E 38TH ST
MARION IN
46953-4568
US

V. Phone/Fax

Practice location:
  • Phone: 800-360-8387
  • Fax:
Mailing address:
  • Phone: 800-360-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014558
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: