Provider Demographics
NPI:1871783548
Name:HESS, DEREK THOMAS (JD, PHD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:THOMAS
Last Name:HESS
Suffix:
Gender:M
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 41ST PL
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2524
Mailing Address - Country:US
Mailing Address - Phone:518-929-2883
Mailing Address - Fax:
Practice Address - Street 1:321 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50319-1002
Practice Address - Country:US
Practice Address - Phone:518-929-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094288103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist