Provider Demographics
NPI:1427065937
Name:ISENHART, CARL (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:ISENHART
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:ONE VETERANS DRIVE
Mailing Address - Street 2:VA MEDICAL CENTER (116A)
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417
Mailing Address - Country:US
Mailing Address - Phone:612-467-3962
Mailing Address - Fax:
Practice Address - Street 1:ONE VETERANS DRIVE
Practice Address - Street 2:VA MEDICAL CENTER (116A)
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417
Practice Address - Country:US
Practice Address - Phone:612-467-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1888103TC0700X
WI1152-057103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical