Provider Demographics
NPI:1124535349
Name:WILLSUN, DEANIN SAVON (LSC)
Entity Type:Individual
Prefix:MRS
First Name:DEANIN
Middle Name:SAVON
Last Name:WILLSUN
Suffix:
Gender:F
Credentials:LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4439
Mailing Address - Country:US
Mailing Address - Phone:763-354-8561
Mailing Address - Fax:
Practice Address - Street 1:3300 COUNTY ROAD 10 # 204B
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3072
Practice Address - Country:US
Practice Address - Phone:763-354-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN476597101YS0200X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool