MEDICARE: DEANNA DEATON PHD, MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	135587-121	WI

General Provider Information

NPI Number	:	1639067499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA DEATON PHD, MSW

Provider Business Mailing Address
First Line	:	190 OWENS RD
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-5514
Country	:	US
Telephone Number	:	334-540-3949
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 OWENS RD
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-5514
Country	:	US
Telephone Number	:	334-540-3949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	06/27/2025

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