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NPI Code Detail

MEDICARE: MRS. DEEANNA DOREEN DENNIS MSW

MEDICARE: MRS. DEEANNA DOREEN DENNIS 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1649314543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEEANNA DOREEN DENNIS MSW
Provider Business Mailing Address
First Line : 10521 NE 22ND ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98664-4214
Country : US
Telephone Number : 360-241-0967
Fax Number :
Provider Business Practice Location Address
First Line : 1500 NE IRVING ST STE 250
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2265
Country : US
Telephone Number : 503-233-4356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 07/08/2007

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