Provider Demographics
NPI:1033291315
Name:VISSER, STANTON L (EDD)
Entity Type:Individual
Prefix:DR
First Name:STANTON
Middle Name:L
Last Name:VISSER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 10TH ST
Mailing Address - Street 2:PO BOX 163
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1630
Mailing Address - Country:US
Mailing Address - Phone:712-476-5245
Mailing Address - Fax:712-476-9621
Practice Address - Street 1:1905 10TH ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1630
Practice Address - Country:US
Practice Address - Phone:712-476-5245
Practice Address - Fax:712-476-9621
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00004101Y00000X
IA00002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist