Provider Demographics
NPI:1487472890
Name:IADEVITO, DIANA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:IADEVITO
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18120 N PEACH BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-4527
Mailing Address - Country:US
Mailing Address - Phone:816-262-6676
Mailing Address - Fax:
Practice Address - Street 1:214 FERREL ST
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9511
Practice Address - Country:US
Practice Address - Phone:816-491-8173
Practice Address - Fax:816-491-8173
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00745103K00000X
MO2024044160103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst