Healthcare Provider Details

I. General information

NPI: 1407844277
Provider Name (Legal Business Name): PHILLIP L KENT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 E 56TH ST
DAVENPORT IA
52807-2995
US

IV. Provider business mailing address

865 LINCOLN RD STE L10
BETTENDORF IA
52722-4190
US

V. Phone/Fax

Practice location:
  • Phone: 563-355-2577
  • Fax: 563-355-4015
Mailing address:
  • Phone: 563-355-9191
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number00929
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00424
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00929
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP1079
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: