Provider Demographics
NPI:1982335998
Name:KAMRADT, JACLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:KAMRADT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S LINN ST APT 306
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1613
Mailing Address - Country:US
Mailing Address - Phone:708-373-9440
Mailing Address - Fax:
Practice Address - Street 1:2140 NORCOR AVE STE 114
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9736
Practice Address - Country:US
Practice Address - Phone:319-975-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical