=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396425880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI KRISTINA GJERDE-KEMPF PHD, BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2023
-----------------------------------------------------
Last Update Date | 07/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 W CHERRY ST
-----------------------------------------------------
City | NORTH LIBERTY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52317-8819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-626-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 CURTIS BRIDGE RD NE
-----------------------------------------------------
City | SWISHER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52338-9590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-325-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 110897
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------