Provider Demographics
NPI:1073532933
Name:SIMS, JEANNIE MOORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:MOORE
Last Name:SIMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:JEANNIE
Other - Middle Name:RUTH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 8TH AVE SE
Mailing Address - Street 2:OELWEIN REGIONAL OFFICE
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662
Mailing Address - Country:US
Mailing Address - Phone:319-283-4135
Mailing Address - Fax:319-283-4140
Practice Address - Street 1:212 8TH AVE SE
Practice Address - Street 2:OELWEIN REGIONAL OFFICE
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662
Practice Address - Country:US
Practice Address - Phone:319-283-4135
Practice Address - Fax:319-283-4140
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA334103T00000X
IA615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13727OtherWELLMARK BCBS
IAI188026Medicare PIN