Provider Demographics
NPI:1053645804
Name:BEEKSMA, DAVID (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BEEKSMA
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3159
Mailing Address - Country:US
Mailing Address - Phone:715-685-0213
Mailing Address - Fax:
Practice Address - Street 1:7665 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:WI
Practice Address - Zip Code:54847-4690
Practice Address - Country:US
Practice Address - Phone:715-372-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2955-57103TC0700X
WI3607-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional