Provider Demographics
NPI:1548075161
Name:RAGLIN, DEANDREA
Entity type:Individual
Prefix:
First Name:DEANDREA
Middle Name:
Last Name:RAGLIN
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 1:8052 MATTERHORN LN APT D115
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1153
Mailing Address - Country:US
Mailing Address - Phone:219-361-8265
Mailing Address - Fax:
Practice Address - Street 1:905 W GLEN PARK AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2028
Practice Address - Country:US
Practice Address - Phone:219-501-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician