Healthcare Provider Details

I. General information

NPI: 1326901166
Provider Name (Legal Business Name): DATASIA DANYALLE VASSOL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 BERTRAND ST
MANHATTAN KS
66502-5122
US

IV. Provider business mailing address

818 BERTRAND ST
MANHATTAN KS
66502-5122
US

V. Phone/Fax

Practice location:
  • Phone: 785-384-8714
  • Fax: 785-414-5410
Mailing address:
  • Phone: 785-384-8714
  • Fax: 785-414-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14513
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: