Provider Demographics
NPI:1043390818
Name:JORDISON, TIMI DEE FRIEDERICHS (PHD; EDS)
Entity Type:Individual
Prefix:DR
First Name:TIMI
Middle Name:DEE FRIEDERICHS
Last Name:JORDISON
Suffix:
Gender:F
Credentials:PHD; EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 CENTRAL AVE
Mailing Address - Street 2:STE. 14
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4200
Mailing Address - Country:US
Mailing Address - Phone:515-573-3628
Mailing Address - Fax:515-573-3682
Practice Address - Street 1:1728 CENTRAL AVE
Practice Address - Street 2:STE. 14
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:515-573-3628
Practice Address - Fax:515-573-3682
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA322774103T00000X
IA001080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07466OtherWELLMARK BC/BS
IA0159608Medicaid