Provider Demographics
NPI:1245889104
Name:PSYCHOLOGY IOWA PLLC
Entity type:Organization
Organization Name:PSYCHOLOGY IOWA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KINDERDIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-277-4357
Mailing Address - Street 1:3703 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5347
Mailing Address - Country:US
Mailing Address - Phone:515-277-4357
Mailing Address - Fax:
Practice Address - Street 1:3703 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5347
Practice Address - Country:US
Practice Address - Phone:515-277-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty