Provider Demographics
NPI:1205407350
Name:BRUNK, DEANNA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:BRUNK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9525
Mailing Address - Country:US
Mailing Address - Phone:208-618-1889
Mailing Address - Fax:
Practice Address - Street 1:1593 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5326
Practice Address - Country:US
Practice Address - Phone:208-262-2441
Practice Address - Fax:208-262-2390
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36545104100000X
IDLCSW424551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker