Provider Demographics
NPI:1215070073
Name:DESMONDE, MARCUS PETER (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:PETER
Last Name:DESMONDE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 37
Mailing Address - Street 2:E6423 836TH AVE
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-0037
Mailing Address - Country:US
Mailing Address - Phone:715-962-2080
Mailing Address - Fax:715-962-2082
Practice Address - Street 1:716 MEDICAL ARTS BLDG
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1721
Practice Address - Country:US
Practice Address - Phone:218-722-3162
Practice Address - Fax:218-722-3162
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1928103T00000X
WI1876057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist