Provider Demographics
NPI:1962731182
Name:WIENTGE, DEANNE E (LICSW)
Entity type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:E
Last Name:WIENTGE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:E
Other - Last Name:DUNSFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-0065
Mailing Address - Country:US
Mailing Address - Phone:425-583-0194
Mailing Address - Fax:
Practice Address - Street 1:619 COMMERCIAL AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1730
Practice Address - Country:US
Practice Address - Phone:425-583-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601098601041C0700X
MO20040241301041C0700X
IL16009241041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool