Provider Demographics
NPI:1790159762
Name:WASSON, BARBARA (LAC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WASSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1503
Mailing Address - Country:US
Mailing Address - Phone:715-381-9965
Mailing Address - Fax:715-381-9963
Practice Address - Street 1:113 2ND ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1503
Practice Address - Country:US
Practice Address - Phone:715-381-9965
Practice Address - Fax:715-381-9963
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI864-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist