Provider Demographics
NPI:1962402206
Name:NAGY, JODI HOWELL (PHD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:HOWELL
Last Name:NAGY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1530 S UNION AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1954
Mailing Address - Country:US
Mailing Address - Phone:253-752-7320
Mailing Address - Fax:253-756-0427
Practice Address - Street 1:1530 S UNION AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1954
Practice Address - Country:US
Practice Address - Phone:253-752-7320
Practice Address - Fax:253-756-0427
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8366288Medicaid
WA8366288Medicaid