Provider Demographics
NPI:1497228019
Name:JAD PLLC
Entity Type:Organization
Organization Name:JAD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-451-3895
Mailing Address - Street 1:2515 UNIVERSITY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8628
Mailing Address - Country:US
Mailing Address - Phone:515-451-3895
Mailing Address - Fax:515-598-7800
Practice Address - Street 1:2515 UNIVERSITY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8628
Practice Address - Country:US
Practice Address - Phone:515-451-3895
Practice Address - Fax:515-598-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health