Provider Demographics
NPI:1992151955
Name:MANSKE, DEANNA (MA/LPC)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:MANSKE
Suffix:
Gender:F
Credentials:MA/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87328 CHINQUAPIN LOOP
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9511
Mailing Address - Country:US
Mailing Address - Phone:541-285-1429
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4192
Practice Address - Country:US
Practice Address - Phone:541-285-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional