Healthcare Provider Details

I. General information

NPI: 1164872172
Provider Name (Legal Business Name): EVAN ROBERT BUIKEMA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LINCOLN WAY SUITE 4
AMES IA
50014-7595
US

IV. Provider business mailing address

3600 LINCOLN WAY STE 4
AMES IA
50014-7595
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4410
  • Fax: 515-663-4885
Mailing address:
  • Phone: 515-239-4410
  • Fax: 515-663-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016700
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number090735
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: