Provider Demographics
NPI:1346576196
Name:KAUDER, JENNIFER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KAUDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 SCOTT CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3952
Mailing Address - Country:US
Mailing Address - Phone:319-338-9960
Mailing Address - Fax:319-338-9492
Practice Address - Street 1:373 SCOTT CT
Practice Address - Street 2:SUITE A
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3952
Practice Address - Country:US
Practice Address - Phone:319-338-9960
Practice Address - Fax:319-338-9492
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001173103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0069468Medicaid