Provider Demographics
NPI:1740789684
Name:SODERSTROM, JOCELYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:
Last Name:SODERSTROM
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 1:218 4TH ST NW STE 1
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2930
Mailing Address - Country:US
Mailing Address - Phone:701-662-8255
Mailing Address - Fax:701-662-1739
Practice Address - Street 1:218 4TH ST NW STE 1
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2930
Practice Address - Country:US
Practice Address - Phone:701-662-8255
Practice Address - Fax:701-662-1739
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical