Doctor Name: | JESSICA A IHNS |
NPI Number: | 1063486330 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 00999 |
Business Practice Address: | 229 S Main St Suite 1 Maquoketa, IA - 520603056 |
Business Phone Number: | 5635527080 |
Business Fax Number: | 8003941580 |
Mailing Address: | 229 S Main St, Suite 1 MAQUOKETA |
State: | IA |
Postal Code: | 520603056 |
Phone Number: | 5635527080 |
Fax Number: | 8003941580 |
NPI Enumeration Date: | 02/14/2006 |
NPI Last Update Date: | 06/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 00999 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |