Provider Demographics
NPI:1164050662
Name:BOETTCHER, DEANNA (MS)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WASHINGTON AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2481
Mailing Address - Country:US
Mailing Address - Phone:320-632-5524
Mailing Address - Fax:888-991-2741
Practice Address - Street 1:16 WASHINGTON AVE W STE 101
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2481
Practice Address - Country:US
Practice Address - Phone:320-632-5524
Practice Address - Fax:888-991-2741
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health