Provider Demographics
NPI:1619208139
Name:GASSAWAY, JOSEPH MICHAEL (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:GASSAWAY
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17512 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-9342
Mailing Address - Country:US
Mailing Address - Phone:816-803-5153
Mailing Address - Fax:
Practice Address - Street 1:17512 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-9342
Practice Address - Country:US
Practice Address - Phone:816-803-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities