Individual
DR. KENNETH L DODGE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3600 LINCOLN WAY, SUITE 4, AMES, IA 50014-7595
(515) 239-4410
(515) 663-4885
Mailing address
118 WATER ST, # 323, DES MOINES, IA 50309-4779
(515) 244-2541
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
00873
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33402
BLUE SHIELD OF IOWA
IA
Enumeration date
01/16/2006
Last updated
07/08/2007
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