Jaclyn Kamradt, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

110183 Issued in IA

Practice address

2140 Norcor Ave Ste 114
Coralville, IA 52241-9736

Phone

(319) 975-8705

NPI assigned

Jun 21, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 26, 2023 through Feb 26, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jaclyn Kamradt PHD, P.C.

  • Clinical Psychologist
  • New Lenox, IL
  • NPI 1396450706
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1982335998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 S LINN ST APT 306",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522401613",
            "telephone_number": "708-373-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 NORCOR AVE STE 114",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522419736",
            "telephone_number": "319-975-8705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMRADT",
        "first_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "110183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Coralville, IA
• Providers in Coralville, IA by specialty
• Clinical Psychologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.