Individual
ILANNAH DESHAZIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
74 PLAIN ST UNIT 74J, BROCKTON, MA 02301-7162
(508) 690-6069
Mailing address
770 CUMMINS HWY APT 10, MATTAPAN, MA 02126-1740
(252) 207-2415
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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