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NPI Code Detail

MEDICARE: DR. DOUGLAS JOHN WESSEL PH.D.

MEDICARE: DR. DOUGLAS JOHN WESSEL PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist176SD

General Provider Information

NPI Number : 1598754806
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS JOHN WESSEL PH.D.
Provider Business Mailing Address
First Line : PO BOX 743
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-0743
Country : US
Telephone Number : 605-584-1215
Fax Number :
Provider Business Practice Location Address
First Line : 1445 NORTH AVE
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-1552
Country : US
Telephone Number : 605-644-4170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 07/08/2007

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