Provider Demographics
NPI:1700300316
Name:DEAN, TRISHA ANN MAULSON (MA)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN MAULSON
Last Name:DEAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 5TH ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2933
Mailing Address - Country:US
Mailing Address - Phone:319-224-5217
Mailing Address - Fax:
Practice Address - Street 1:1150 5TH ST STE 270
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2933
Practice Address - Country:US
Practice Address - Phone:319-224-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist