Provider Demographics
NPI:1790018638
Name:DEAN, MARGARET SUE (PHD/CCC-A)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:SUE
Last Name:DEAN
Suffix:
Gender:F
Credentials:PHD/CCC-A
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:SUE
Other - Last Name:GILLIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:612-351-1529
Mailing Address - Fax:
Practice Address - Street 1:1001 BUCHANAN DR STE 11
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2329
Practice Address - Country:US
Practice Address - Phone:956-544-2783
Practice Address - Fax:956-544-5160
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51320231H00000X, 237600000X
TX237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2072050-03OtherMEDICARE