Provider Demographics
NPI:1164669594
Name:DRWAL, JASON MATTHEW (PH D)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:DRWAL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 LOCKMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8042
Mailing Address - Country:US
Mailing Address - Phone:319-853-8762
Mailing Address - Fax:319-249-6875
Practice Address - Street 1:595 ASHLEY CT STE 5
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4758
Practice Address - Country:US
Practice Address - Phone:319-853-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical