Provider Demographics
NPI:1891531588
Name:BENNETT, DEANNA BEATRICE (LPC-IT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:BEATRICE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:LUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 PROGRESS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2520
Mailing Address - Country:US
Mailing Address - Phone:608-849-5430
Mailing Address - Fax:
Practice Address - Street 1:251 PROGRESS WAY STE 102
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2520
Practice Address - Country:US
Practice Address - Phone:608-849-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7999-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health