1093041840 NPI number — DR. JILL JORDAHL-BALL PSYD

Table of content: DR. JILL JORDAHL-BALL PSYD (NPI 1093041840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093041840 NPI number — DR. JILL JORDAHL-BALL PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAHL-BALL
Provider First Name:
JILL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093041840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3510 LINCOLN WAY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50014-8534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-292-9251
Provider Business Mailing Address Fax Number:
844-895-6179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3510 LINCOLN WAY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50014-8534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-292-9251
Provider Business Practice Location Address Fax Number:
844-895-6179
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 001168 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)