Healthcare Provider Details

I. General information

NPI: 1891158432
Provider Name (Legal Business Name): DAVID ROY DRUSTRUP PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 WOODLAND AVE STE 102
WEST DES MOINES IA
50266-6504
US

IV. Provider business mailing address

3408 WOODLAND AVE STE 102
WEST DES MOINES IA
50266-6504
US

V. Phone/Fax

Practice location:
  • Phone: 515-612-8413
  • Fax:
Mailing address:
  • Phone: 515-612-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number122027
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0051
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2336
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: