Provider Demographics
NPI:1992100978
Name:WASSELL, DIANA J (BCBA)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:J
Last Name:WASSELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 STONE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2253
Mailing Address - Country:US
Mailing Address - Phone:712-898-3303
Mailing Address - Fax:
Practice Address - Street 1:3251 STONE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2253
Practice Address - Country:US
Practice Address - Phone:712-898-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst