Healthcare Provider Details

I. General information

NPI: 1215070073
Provider Name (Legal Business Name): MARCUS PETER DESMONDE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 MEDICAL ARTS BLDG
DULUTH MN
55802-1721
US

IV. Provider business mailing address

BOX 37 E6423 836TH AVE
COLFAX WI
54730-0037
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-3162
  • Fax: 218-722-3162
Mailing address:
  • Phone: 715-962-2080
  • Fax: 715-962-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1928
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1876057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: