Healthcare Provider Details

I. General information

NPI: 1427125400
Provider Name (Legal Business Name): KENNETH DALE HASSELER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNDERWOOD ST
ZANESVILLE OH
43701-3771
US

IV. Provider business mailing address

601 UNDERWOOD ST
ZANESVILLE OH
43701-3771
US

V. Phone/Fax

Practice location:
  • Phone: 605-838-8403
  • Fax:
Mailing address:
  • Phone: 605-838-8403
  • Fax: 740-261-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS016529
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301009161
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number502
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6301009161
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number502
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberP.07601
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPS016529
License Number StatePA
# 8
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP.07601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: