Provider Demographics
NPI:1477368967
Name:BASTRON, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BASTRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7105 NE 40TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3058
Mailing Address - Country:US
Mailing Address - Phone:360-993-3129
Mailing Address - Fax:
Practice Address - Street 1:7105 NE 40TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3058
Practice Address - Country:US
Practice Address - Phone:360-993-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health