Provider Demographics
NPI:1487745402
Name:KAESSER, DONALD M (PH D)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:KAESSER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3321
Mailing Address - Country:US
Mailing Address - Phone:515-240-7997
Mailing Address - Fax:515-282-5570
Practice Address - Street 1:1922 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3321
Practice Address - Country:US
Practice Address - Phone:515-240-7997
Practice Address - Fax:515-282-5570
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00550103T00000X, 103TC1900X, 103TA0400X
IA00166103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0047894Medicaid
IA119051Medicare PIN
IA0047894Medicaid