Provider Demographics
NPI:1417573510
Name:STAPLES, DEANNA M (LADC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:M
Last Name:STAPLES
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7701 YORK AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-926-2526
Mailing Address - Fax:952-926-6791
Practice Address - Street 1:7701 YORK AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-926-2526
Practice Address - Fax:952-926-6791
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302236101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)