Provider Demographics
NPI:1619225612
Name:BARTHLOW-POTKANOWICZ, DEANNA L (PHD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:BARTHLOW-POTKANOWICZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:L
Other - Last Name:POTKANOWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:402 N BLACKFORD ST, LD 124
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3217
Mailing Address - Country:US
Mailing Address - Phone:317-278-2515
Mailing Address - Fax:
Practice Address - Street 1:402 N BLACKFORD ST, LD 124
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3217
Practice Address - Country:US
Practice Address - Phone:317-278-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2025-08-08
Deactivation Date:2013-06-25
Deactivation Code:
Reactivation Date:2025-08-07
Provider Licenses
StateLicense IDTaxonomies
OH6265103TC0700X
IN20041844A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical