Healthcare Provider Details

I. General information

NPI: 1467475509
Provider Name (Legal Business Name): DEANNA STOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA CATOVIC

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LAKEVIEW DRIVE
CAMDENTON MO
65020-7108
US

IV. Provider business mailing address

ARMY SUBSTANCE ABUSE PROGRAM USAG WIESBADEN UNIT 29623
APO AE GERMANY
09096
DE

V. Phone/Fax

Practice location:
  • Phone: 573-814-6580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29014
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: