MEDICARE: FITZGERALD PSYCHOLOGICAL SERVICES, P.S.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1710322755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITZGERALD PSYCHOLOGICAL SERVICES, P.S.

Provider Business Mailing Address
First Line	:	629 6TH ST
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2010
Country	:	US
Telephone Number	:	509-758-9698
Fax Number	:	509-758-9664

Provider Business Practice Location Address
First Line	:	629 6TH ST
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2010
Country	:	US
Telephone Number	:	509-758-9698
Fax Number	:	509-758-9664

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. JAROD JOHN FITZGERALD
Credential	:	PH.D.
Telephone Number	:	509-758-9698

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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