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General NPI Number Information
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NPI Number | 1255296679
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Entity Type | Individual
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Provider Name | JESUS MANUEL PICHARDO JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 600 BLANK HONORS CTR
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City | IOWA CITY
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State | IA
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Zip | 52242-0454
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Country | US
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Telephone | 319-335-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 600 BLANK HONORS CTR
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City | IOWA CITY
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State | IA
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Zip | 52242-0454
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Country | US
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Telephone | 319-335-6148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 135269
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 128674
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License Number State | IA
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