Provider Demographics
NPI:1538179007
Name:VONSTADE, CHRISTOPHER R (EDD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:VONSTADE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WEST CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317
Mailing Address - Country:US
Mailing Address - Phone:319-626-3300
Mailing Address - Fax:319-626-3084
Practice Address - Street 1:320 WEST CHERRY STREET
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-626-3300
Practice Address - Fax:319-626-3084
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00821103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1160317Medicaid
IA680015960OtherRAILROAD MEDICARE
IA40OtherMIDLANDS CHOICE
IA40729Medicare ID - Type UnspecifiedMEDICARE