Healthcare Provider Details

I. General information

NPI: 1972391084
Provider Name (Legal Business Name): JACE DAVIDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 ASHWORTH RD STE 210
WEST DES MOINES IA
50266-5954
US

IV. Provider business mailing address

1290 JORDAN ST
NORTH LIBERTY IA
52317-8020
US

V. Phone/Fax

Practice location:
  • Phone: 515-644-8224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: