Healthcare Provider Details

I. General information

NPI: 1063486330
Provider Name (Legal Business Name): JESSICA A IHNS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A SCHMIDT PSY.D.

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S MAIN ST SUITE 1
MAQUOKETA IA
52060-3056
US

IV. Provider business mailing address

229 S MAIN ST SUITE 1
MAQUOKETA IA
52060-3056
US

V. Phone/Fax

Practice location:
  • Phone: 563-552-7080
  • Fax: 800-394-1580
Mailing address:
  • Phone: 563-552-7080
  • Fax: 800-394-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00999
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00999
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00999
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: