Provider Demographics
NPI:1578803540
Name:WELLS, DEANNA BROOK
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:BROOK
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEANNA
Other - Middle Name:BROOK
Other - Last Name:COLLINS-WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9830 NE CASCADES PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-6834
Mailing Address - Country:US
Mailing Address - Phone:503-239-8101
Mailing Address - Fax:503-262-1951
Practice Address - Street 1:9830 NE CASCADES PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-6834
Practice Address - Country:US
Practice Address - Phone:503-239-8101
Practice Address - Fax:503-262-1951
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker