{
"Npi": {
"NPI": "1215070073",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DESMONDE",
"FirstName": "MARCUS",
"MiddleName": "PETER",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSYD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "BOX 37",
"SecondLineMailingAddress": "E6423 836TH AVE",
"MailingAddressCityName": "COLFAX",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54730-0037",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-962-2080",
"MailingAddressFaxNumber": "715-962-2082",
"FirstLinePracticeLocationAddress": "716 MEDICAL ARTS BLDG",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DULUTH",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55802-1721",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-722-3162",
"PracticeLocationAddressFaxNumber": "218-722-3162",
"EnumerationDate": "02/14/2007",
"LastUpdateDate": "01/11/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "1928",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "1876057",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}