Healthcare Provider Details

I. General information

NPI: 1770629560
Provider Name (Legal Business Name): PAUL ESSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SW ANKENY RD
ANKENY IA
50023-9798
US

IV. Provider business mailing address

715 SW ANKENY RD
ANKENY IA
50023-9798
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-1339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number933
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: