Provider Demographics
NPI:1699380469
Name:MARTENS, DEANNA (MSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MARTENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SOUTHSHORE DR WATERSTONE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371
Mailing Address - Country:US
Mailing Address - Phone:248-890-9376
Mailing Address - Fax:
Practice Address - Street 1:3604 CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5215
Practice Address - Country:US
Practice Address - Phone:248-595-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020786031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical