Healthcare Provider Details

I. General information

NPI: 1952584278
Provider Name (Legal Business Name): ANN FURUSETH SIMCOX PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N ELM ST STE 120
PLATTEVILLE WI
53818-1205
US

IV. Provider business mailing address

1882 CREEK WOOD DR
DUBUQUE IA
52003-7605
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-4060
  • Fax: 608-348-4191
Mailing address:
  • Phone: 507-696-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number077441
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3639-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: