Provider Demographics
NPI:1982324943
Name:HUTTON, DEANNA KAY (MSW)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KAY
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5522
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-5522
Mailing Address - Country:US
Mailing Address - Phone:505-258-4629
Mailing Address - Fax:505-436-2608
Practice Address - Street 1:116 N WALL AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6916
Practice Address - Country:US
Practice Address - Phone:505-258-4629
Practice Address - Fax:505-436-2608
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-0399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker