Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 00514 | IA |
N | 103TC0700X | Clinical Psychologist | 00514 | IA |
N | 102L00000X | Psychologist | 00514 | IA |
N | 103T00000X | Psychologist | 00514 | IA |
N | 103TA0700X | Adult Development & Aging Psychologist | 00514 | IA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 00514 | IA |
N | 103TC1900X | Counseling Psychologist | 00514 | IA |
N | 103TH0100X | Health Service | 00514 | IA |
N | 103TP2701X | Group Psychotherapist | 00514 | IA |
N | 103TR0400X | Rehabilitation Psychologist | 00514 | IA |
NPI | 1760430672 |
---|---|
Provider Name | Dr. David F. Dettmann |
First Address | Pella, IA 50219-7513 |
Second Address | Knoxville, IA 50138-3354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |