Provider Demographics
NPI:1295004240
Name:JASPERSON, DIANE D
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:D
Last Name:JASPERSON
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 1:1106 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WI
Mailing Address - Zip Code:54007-4106
Mailing Address - Country:US
Mailing Address - Phone:715-497-0901
Mailing Address - Fax:
Practice Address - Street 1:2231 US HIGHWAY 12
Practice Address - Street 2:SUITE 201
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-3269
Practice Address - Country:US
Practice Address - Phone:715-684-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2488-024225100000X
MN2151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist