Provider Demographics
NPI:1013278258
Name:PRELLWITZ, DEANNA ROBINSON
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ROBINSON
Last Name:PRELLWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 NINA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-8928
Mailing Address - Country:US
Mailing Address - Phone:502-468-5935
Mailing Address - Fax:
Practice Address - Street 1:3211 GRANT LINE RD STE 15
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2175
Practice Address - Country:US
Practice Address - Phone:502-417-9830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst