Provider Demographics
NPI:1265800577
Name:WRIGHT-COFFMAN, DEANNA (LCSW)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:WRIGHT-COFFMAN
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 1:14605 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2656
Mailing Address - Country:US
Mailing Address - Phone:314-415-6997
Mailing Address - Fax:314-415-4973
Practice Address - Street 1:14605 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2656
Practice Address - Country:US
Practice Address - Phone:314-415-6997
Practice Address - Fax:314-415-4973
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050269001041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool