Provider Demographics
NPI:1356843510
Name:GRUESER, DIANNA (MASTER OF EDUCATION,)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:GRUESER
Suffix:
Gender:F
Credentials:MASTER OF EDUCATION,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 US ROUTE 60 W
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1133
Mailing Address - Country:US
Mailing Address - Phone:304-743-8160
Mailing Address - Fax:606-388-4512
Practice Address - Street 1:1707 US ROUTE 60 W
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1133
Practice Address - Country:US
Practice Address - Phone:304-743-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-21-51351103K00000X
WV11112080P0006X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist