Healthcare Provider Details

I. General information

NPI: 1477983120
Provider Name (Legal Business Name): DONALD M. KAESSER PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 INGERSOLL AVE
DES MOINES IA
50309-3321
US

IV. Provider business mailing address

1922 INGERSOLL AVE
DES MOINES IA
50309-3321
US

V. Phone/Fax

Practice location:
  • Phone: 515-240-7997
  • Fax: 515-267-0556
Mailing address:
  • Phone: 515-240-7997
  • Fax: 515-267-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0550
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0550
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0550
License Number StateIA

VIII. Authorized Official

Name: DONALD M. KAESSER
Title or Position: CEO
Credential: PHD
Phone: 515-240-7997