Healthcare Provider Details

I. General information

NPI: 1255296679
Provider Name (Legal Business Name): JESUS MANUEL PICHARDO JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ZEUS PICHARDO PH.D

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BLANK HONORS CTR
IOWA CITY IA
52242-0454
US

IV. Provider business mailing address

600 BLANK HONORS CTR
IOWA CITY IA
52242-0454
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-6148
  • Fax:
Mailing address:
  • Phone: 319-335-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number135269
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number128674
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: