Healthcare Provider Details

I. General information

NPI: 1598988024
Provider Name (Legal Business Name): EUGENE R DEISINGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 ELWOOD DR STE 121
AMES IA
50010-8229
US

IV. Provider business mailing address

2521 ELWOOD DR STE 121
AMES IA
50010-8229
US

V. Phone/Fax

Practice location:
  • Phone: 515-460-2898
  • Fax:
Mailing address:
  • Phone: 515-460-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number00720
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: