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General NPI Number Information
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NPI Number | 1619203379
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Entity Type | Organization
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Legal Business Name | TIMI JORDISON PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 1728 CENTRAL AVE SUITE 14
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City | FORT DODGE
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State | IA
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Zip | 50501-4200
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Country | US
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Telephone | 515-573-3628
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Fax | 515-573-3628
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Provider Business Mailing Address
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Address Line | 1728 CENTRAL AVE SUITE 14
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City | FORT DODGE
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State | IA
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Zip | 50501-4200
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Country | US
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Telephone | 515-573-3628
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Fax | 515-573-3628
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. TIMI DEE FRIEDERICHS JORDISON
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Credential | PH.D.
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Telephone | 515-573-3628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 001080
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License Number State | IA
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