Provider Demographics
NPI:1598988024
Name:DEISINGER, EUGENE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:R
Last Name:DEISINGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 ELWOOD DR STE 121
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8229
Mailing Address - Country:US
Mailing Address - Phone:515-460-2898
Mailing Address - Fax:
Practice Address - Street 1:2521 ELWOOD DR STE 121
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8229
Practice Address - Country:US
Practice Address - Phone:515-460-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00720103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling