Provider Demographics
NPI:1447223763
Name:VELTKAMP, JODY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ANN
Last Name:VELTKAMP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 E BAKERVIEW ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-676-7445
Mailing Address - Fax:360-733-4339
Practice Address - Street 1:192 E BAKERVIEW ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-676-7445
Practice Address - Fax:360-733-4339
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2540103G00000X
WAPY00002540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S45242Medicare UPIN
WAGAB23603Medicare UPIN
WAS45242Medicare PIN