Provider Demographics
NPI:1427125400
Name:HASSELER, KENNETH DALE (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DALE
Last Name:HASSELER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3771
Mailing Address - Country:US
Mailing Address - Phone:605-838-8403
Mailing Address - Fax:740-261-5066
Practice Address - Street 1:601 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3771
Practice Address - Country:US
Practice Address - Phone:605-838-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016529103G00000X, 103TR0400X, 103TR0400X
MI6301009161103G00000X, 103TR0400X, 103TR0400X
SD502103G00000X, 103TR0400X, 103TR0400X
OHP.07601103TR0400X, 103G00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS40574Medicare ID - Type UnspecifiedUPN