Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 00550 | IA |
N | 103T00000X | Psychologist | 00550 | IA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 00550 | IA |
Y | 103TC1900X | Counseling Psychologist | 00550 | IA |
N | 103TH0100X | Health Service | 00166 | IA |
NPI | 1487745402 |
---|---|
Provider Name | Dr. Donald M Kaesser |
First Address | Des Moines, IA 50309-3321 |
Second Address | Des Moines, IA 50309-3321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 07/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0047894 | (05) | IA |