Provider Demographics
NPI:1497422109
Name:VANSICKLE, DIANA ELIZABETH (NONE)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELIZABETH
Last Name:VANSICKLE
Suffix:
Gender:F
Credentials:NONE
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Other - Credentials:
Mailing Address - Street 1:18726 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:201 KING OF PRUSSIA RD STE 650
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5156
Practice Address - Country:US
Practice Address - Phone:215-853-6682
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician