Provider Demographics
NPI:1316241417
Name:SORDAHL, JEFF ALAN JR (PSYD)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:ALAN
Last Name:SORDAHL
Suffix:JR
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:444 W FORT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4535
Mailing Address - Country:US
Mailing Address - Phone:208-422-1018
Mailing Address - Fax:
Practice Address - Street 1:2463 E GALA ST STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5210
Practice Address - Country:US
Practice Address - Phone:208-955-7333
Practice Address - Fax:208-955-7330
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPSY202763103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist