Individual
DR. DIANE JOHNSON PROSSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
227 N DIXIE WAY STE 110, SOUTH BEND, IN 46637-3366
(574) 850-8486
(574) 966-1585
Mailing address
227 N DIXIE WAY STE 110, SOUTH BEND, IN 46637-3366
(574) 850-8486
(574) 966-1585
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
01/12/2007
Last updated
05/16/2016
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