MEDICARE: DR. JACLYN KAMRADT PHD

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
1	103TC0700X	Clinical Psychologist	110183	IA

General Provider Information

NPI Number	:	1982335998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN KAMRADT PHD

Provider Business Mailing Address
First Line	:	332 S LINN ST APT 306
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1613
Country	:	US
Telephone Number	:	708-373-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 NORCOR AVE STE 114
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-9736
Country	:	US
Telephone Number	:	319-975-8705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	07/27/2022

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