Provider Demographics
NPI:1609361401
Name:HOUCK, DEANNA LYNN I (BS,)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:HOUCK
Suffix:I
Gender:F
Credentials:BS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DEWITT ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2114
Mailing Address - Country:US
Mailing Address - Phone:608-745-9292
Mailing Address - Fax:608-280-2707
Practice Address - Street 1:322 DEWITT ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2114
Practice Address - Country:US
Practice Address - Phone:608-745-9292
Practice Address - Fax:608-280-2707
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171M00000X
WI10201-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator