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NPI Code Detail

MEDICARE: DR. JENNIFER IVELAND PSYD

MEDICARE: DR. JENNIFER IVELAND PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist560WY

General Provider Information

NPI Number : 1356718977
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER IVELAND PSYD
Provider Business Mailing Address
First Line : 1650 COCHRANE CIR BLDG 1657
Second Line : EVANS ARMY COMMUNITY HOSPITAL
City : FORT CARSON
State : CO
Zip : 80913-4613
Country : US
Telephone Number : 719-526-3547
Fax Number :
Provider Business Practice Location Address
First Line : 1650 COCHRANE CIR BLDG 1657
Second Line : EVANS ARMY COMMUNITY HOSPITAL
City : FORT CARSON
State : CO
Zip : 80913-4613
Country : US
Telephone Number : 719-526-3547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2015
Last Update Date : 01/23/2017

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