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General NPI Number Information
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NPI Number | 1215070073
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Entity Type | Individual
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Provider Name | MARCUS PETER DESMONDE PSYD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 716 MEDICAL ARTS BLDG
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City | DULUTH
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State | MN
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Zip | 55802-1721
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Country | US
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Telephone | 218-722-3162
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Fax | 218-722-3162
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Provider Business Mailing Address
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Address Line | BOX 37 E6423 836TH AVE
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City | COLFAX
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State | WI
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Zip | 54730-0037
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Country | US
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Telephone | 715-962-2080
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Fax | 715-962-2082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1928
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1876057
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License Number State | WI
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