Provider Demographics
NPI:1003219593
Name:RANGEL, DEANDRA
Entity Type:Individual
Prefix:
First Name:DEANDRA
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANDRA
Other - Middle Name:
Other - Last Name:BOCKHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4446
Mailing Address - Country:US
Mailing Address - Phone:217-592-0338
Mailing Address - Fax:
Practice Address - Street 1:612 N 11TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2662
Practice Address - Country:US
Practice Address - Phone:217-224-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker