Provider Demographics
NPI:1790903409
Name:HOWARD, DALEAN MARIE
Entity Type:Individual
Prefix:MS
First Name:DALEAN
Middle Name:MARIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DALEAN
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-0008
Mailing Address - Country:US
Mailing Address - Phone:360-807-8779
Mailing Address - Fax:360-807-8779
Practice Address - Street 1:111 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4315
Practice Address - Country:US
Practice Address - Phone:360-807-8779
Practice Address - Fax:360-807-8779
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015282171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty