Provider Demographics
NPI:1598324402
Name:HORNSBY, DAISIA
Entity type:Individual
Prefix:
First Name:DAISIA
Middle Name:
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1325
Mailing Address - Country:US
Mailing Address - Phone:951-203-6690
Mailing Address - Fax:
Practice Address - Street 1:56100 BITTERSWEET RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-7715
Practice Address - Country:US
Practice Address - Phone:574-258-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN000010395103TS0200X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool