Organization
DIANE JOHNSON PROSSER, PHD., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE JOHNSON PROSSER HSPP (SOLE PROPRIETOR)
(574) 850-8486
Entity
Organization
Contact information
Practice address
227 N DIXIE WAY, SUITE 110, SOUTH BEND, IN 46637-3385
(574) 850-8486
(574) 966-1580
Mailing address
227 N DIXIE WAY, SUITE 110, SOUTH BEND, IN 46637-3385
(574) 850-8486
(574) 966-1580
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040993
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200122760A
—
IN
Enumeration date
05/17/2016
Last updated
05/17/2016
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