Provider Demographics
NPI:1720464076
Name:VASSAUX, JOSEPH (STUDENT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:VASSAUX
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8503 LEADER DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8666
Mailing Address - Country:US
Mailing Address - Phone:614-378-0597
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE AND MAIN
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-7812
Practice Address - Country:US
Practice Address - Phone:614-378-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTX481501390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program