MEDICARE: DR. JASON MATTHEW DRWAL PH. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	001126	IA

General Provider Information

NPI Number	:	1164669594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MATTHEW DRWAL PH. D.

Provider Business Mailing Address
First Line	:	144 LOCKMOOR CIR
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-8042
Country	:	US
Telephone Number	:	319-853-8762
Fax Number	:	319-249-6875

Provider Business Practice Location Address
First Line	:	595 ASHLEY CT STE 5
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4758
Country	:	US
Telephone Number	:	319-853-8762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	12/09/2022

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