Healthcare Provider Details

I. General information

NPI: 1598709214
Provider Name (Legal Business Name): MARY DATSON EGGERT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER, PSYCHOLOGY 116B HIGHWAY 6 EAST
IOWA CITY IA
52246
US

IV. Provider business mailing address

2519 AARON DR SE
IOWA CITY IA
52240-9002
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone: 319-338-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number507
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: