Provider Demographics
NPI:1063836070
Name:DEAN, MARIA (BSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:MOLLER-GUNDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:514 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3631
Mailing Address - Country:US
Mailing Address - Phone:262-548-7338
Mailing Address - Fax:262-970-6697
Practice Address - Street 1:514 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3631
Practice Address - Country:US
Practice Address - Phone:262-548-7338
Practice Address - Fax:262-970-6697
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator