Provider Information for 1750824678
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DEANDRA POYTHRESS LISW-S
Sex: Female
NPI: 1750824678
Last Updated: 2025-01-28
Certification Date: 2025-01-28
Certification Date: 2025-01-28
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1750824678 | ||||||||
| Enumeration Date | 2016-11-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 7232 JUSTIN WAY MENTOR, OH 44060-4881 United States Phone: 440-578-8200 | Fax: | ||||||||
| Primary Practice Address | 210 US HIGHWAY 89 W BROWNING, MT 59417-8233 United States Phone: 406-338-3200 | Fax: | ||||||||
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