Provider Demographics
NPI:1649314543
Name:DENNIS, DEEANNA DOREEN (MSW)
Entity type:Individual
Prefix:MRS
First Name:DEEANNA
Middle Name:DOREEN
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DEEANNA
Other - Middle Name:DOREEN
Other - Last Name:GARCIA DENNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:10521 NE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4214
Mailing Address - Country:US
Mailing Address - Phone:360-241-0967
Mailing Address - Fax:
Practice Address - Street 1:1500 NE IRVING ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2265
Practice Address - Country:US
Practice Address - Phone:503-233-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical