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General NPI Number Information
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NPI Number | 1871267591
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Entity Type | Individual
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Provider Name | MADELINE R DESHAZER
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Gender | Female
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 9 KENNY DR
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City | ATHENS
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State | OH
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Zip | 45701-9406
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Country | US
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Telephone | 913-271-4884
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Fax |
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Provider Business Mailing Address
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Address Line | 1 OHIO UNIVERSITY DEPT OF PSYCHOLOGY PORTER HALL ROOM 002
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City | ATHENS
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State | OH
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Zip | 45701-2942
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Country | US
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Telephone | 740-593-0902
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Fax | 740-593-4790
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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