Basic Information
| Provider Information | |||||||||
| NPI: | 1164878252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRANKEL | ||||||||
| FirstName: | DEANNA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 GAYLORD DR | ||||||||
| Address2: | |||||||||
| City: | COLLINSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622344825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189793877 | ||||||||
| FaxNumber: | 3143447736 | ||||||||
| Practice Location | |||||||||
| Address1: | 12303 DEPAUL DRIVE | ||||||||
| Address2: | ST. VINCENT'S BEHAVIORAL HEATLH SERVICES | ||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143446560 | ||||||||
| FaxNumber: | 3143447736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 005359 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.