Healthcare Provider Details

I. General information

NPI: 1336082031
Provider Name (Legal Business Name): DEANNA C HAVRANEK CADC, CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 FRUITDALE DR
GRANTS PASS OR
97527-5267
US

IV. Provider business mailing address

311 SE L ST APT A
GRANTS PASS OR
97526-3188
US

V. Phone/Fax

Practice location:
  • Phone: 541-479-8847
  • Fax:
Mailing address:
  • Phone: 541-479-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-26-6582
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: