Provider Demographics
NPI:1811553514
Name:MOZO HELLWICH, DEANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:MOZO HELLWICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DEANNA
Other - Middle Name:JEAN MOZO
Other - Last Name:HELLWICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:17155 AVOCET DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2399
Mailing Address - Country:US
Mailing Address - Phone:907-947-5514
Mailing Address - Fax:
Practice Address - Street 1:63220 SILVIS RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9743
Practice Address - Country:US
Practice Address - Phone:541-280-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5759101YP2500X
ORC6344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500767548Medicaid