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General NPI Number Information
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NPI Number | 1649275793
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Entity Type | Individual
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Provider Name | KEITH F GIBSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 2100 ASBURY RD STE 5
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City | DUBUQUE
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State | IA
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Zip | 52001-3091
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Country | US
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Telephone | 563-556-1225
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Fax | 563-556-0713
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Provider Business Mailing Address
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Address Line | 2100 ASBURY RD STE 5
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City | DUBUQUE
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State | IA
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Zip | 52001-3091
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Country | US
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Telephone | 563-556-1225
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Fax | 563-556-0713
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 342
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License Number State | IA
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