Provider Demographics
NPI:1386751113
Name:SEATON, BRENT E (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:E
Last Name:SEATON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-949-3059
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:SUITE BS
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2800
Practice Address - Country:US
Practice Address - Phone:641-422-7797
Practice Address - Fax:641-422-7516
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00888103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0232249Medicaid
IA41255OtherWELLMARK
IAP26105Medicare UPIN
IAI1485Medicare ID - Type Unspecified