Active NPI
Kenneth L Dodge, PH.D.
- Clinical Psychologist
- Ames, IA
National Provider Identifier
1942289152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 00873
- Practice address
- 3600 Lincoln Way
Suite 4
Ames, IA 50014-7595 - Phone
- (515) 239-4410
- Fax
- (515) 663-4885
- NPI assigned
- Jan 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 00873 | IA | Primary |
Addresses
Primary practice location
3600 Lincoln Way
Suite 4
Ames, IA 50014-7595
Mailing address
118 Water St
# 323
Des Moines, IA 50309-4779
Phone (515) 244-2541
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33402 | Other | IA | BLUE SHIELD OF IOWA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00873 | IA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1942289152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 WATER ST",
"address_2": "# 323",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503094779",
"telephone_number": "515-244-2541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 LINCOLN WAY",
"address_2": "SUITE 4",
"city": "AMES",
"state": "IA",
"postal_code": "500147595",
"telephone_number": "515-239-4410",
"fax_number": "515-663-4885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "KENNETH",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-16",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "00873",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF IOWA",
"identifier": "33402",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ames, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.