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General NPI Number Information
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NPI Number | 1205407350
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Entity Type | Individual
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Provider Name | DEANNA MARIE BRUNK LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1551 E MULLAN AVE STE 200D
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City | POST FALLS
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State | ID
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Zip | 83854-9005
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Country | US
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Telephone | 208-262-2441
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Fax | 208-262-2390
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Provider Business Mailing Address
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Address Line | 226 S SUNSET DR
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City | POST FALLS
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State | ID
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Zip | 83854-9525
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Country | US
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Telephone | 208-618-1889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-36545
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW42455
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License Number State | ID
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