Provider Demographics
NPI:1780872374
Name:GEHL, CARISSA R (PHD)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:R
Last Name:GEHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:R
Other - Last Name:NEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6963
Mailing Address - Fax:319-356-2587
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6963
Practice Address - Fax:319-356-2587
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5020103G00000X, 103TC0700X
IA001204103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical