Healthcare Provider Details

I. General information

NPI: 1740789684
Provider Name (Legal Business Name): JOCELYN SODERSTROM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 4TH ST NW STE 1
DEVILS LAKE ND
58301-2930
US

IV. Provider business mailing address

218 4TH ST NW STE 1
DEVILS LAKE ND
58301-2930
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-8255
  • Fax: 701-662-1739
Mailing address:
  • Phone: 701-662-8255
  • Fax: 701-662-1739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number548
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: