Individual
DIANNA MICHELLE CASTLEBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1166 MASON ST, BARRY, IL 62312-1137
(217) 335-2961
Mailing address
PO BOX 24, BARRY, IL 62312-0024
(217) 335-2961
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-364764
—
IL
Enumeration date
10/27/2020
Last updated
11/24/2020
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