Provider Demographics
NPI:1629169263
Name:BRUNSCHEEN, SUMMER K (PHD)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:K
Last Name:BRUNSCHEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VALLEY WEST DR
Mailing Address - Street 2:SUITE 707
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1908
Mailing Address - Country:US
Mailing Address - Phone:515-222-1999
Mailing Address - Fax:515-224-3949
Practice Address - Street 1:319 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3309
Practice Address - Country:US
Practice Address - Phone:515-233-1122
Practice Address - Fax:515-233-6500
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00887101YM0800X
IA1020103T00000X
IA000490103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service