Provider Demographics
NPI:1457363632
Name:REESE, DEANN LEA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DEANN
Middle Name:LEA
Last Name:REESE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:DEANN
Other - Middle Name:LEA
Other - Last Name:HOUTSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:612 ADOBE CIR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 BROADWAY ST STE 7
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1981
Practice Address - Country:US
Practice Address - Phone:320-634-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42274OtherSIOUX VALLEY HEALTH
MNHP49874OtherHEALTH PARTNERS
MN1043050OtherPREFERRED ONE
MN113291OtherUCARE
MN10005OtherAVERA HEALTH PLAN
MN557T9REOtherBLUE CROSS BLUE SHIELD
MN534148500Medicaid