Provider Demographics
NPI:1619090735
Name:DEANE, SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:DEANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NW EASTMAN PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3858
Mailing Address - Country:US
Mailing Address - Phone:503-665-4357
Mailing Address - Fax:503-665-3260
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-665-4357
Practice Address - Fax:503-665-3260
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical