MR. JEFF ALAN SORDAHL JR. (NPI# 1316241417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316241417 |
| Entity Type | Individual |
| Full Name | MR. JEFF ALAN SORDAHL JR. |
| Credential | PSY.D. |
| Practice Address |
500 W Fort St Boise ID 83702-4501 |
| Practice Telephone | 2084221000 |
| Mailing Telephone | 2084221000 |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2015-10-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PSY202763 | ID | Behavioral Health & Social Service Providers |
| Street Address |
500 W FORT ST |
| City | BOISE |
| State | ID |
| Zip Code | 83702-4501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063411007 | Sandra Gee Jue | Pharmacist | 500 W Fort St, Bldg 44a, Boise, ID 83702-4501 | 2005-07-20 |
| 1952902389 | Christine Alice Walsh | Recreation Therapist | 500 W Fort St, Boise, ID 83702-4501 | 2020-11-03 |
| 1386243160 | Elizabeth Larsen | Registered Nurse | 500 W Fort St, Boise, ID 83702-4598 | 2020-10-22 |
| 1013516293 | Rebecca Cotterell | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-10-20 |
| 1487253670 | Morgan Wussow | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-10-20 |
| 1548867435 | Justin Hyer | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-10-05 |
| 1881209336 | Daniel James Councell | Physician Assistant | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-11 |
| 1508470451 | Marcus J Day | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-08 |
| 1386258291 | Vanessa Potoski | Registered Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-08 |
| 1033723788 | Brian Lynn Lambrecht | Licensed Practical Nurse | 500 W Fort St, Boise, ID 83702-4501 | 2020-09-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295954485 | Saint Alphonsus Regional Medical Center Inc | Clinical Neuropsychologist | 717 N Liberty St, Boise, ID 83704-9342 | 2007-04-25 |
| 1952443640 | Christine Pickford | Clinical Neuropsychologist | 1104 N 18th St, Boise, ID 83702-3321 | 2007-02-12 |
| 1225176498 | Craig W. Beaver | Clinical Neuropsychologist | 250 Bobwhite Ct Ste 220, Boise, ID 83706-3983 | 2007-02-01 |
| 1326008053 | David E Nilsson | Clinical Neuropsychologist | 2537 W. State St., Suite 210, Boise, ID 83702 | 2006-03-25 |
| 1790241404 | Boise Brain Health | Clinical Neuropsychologist | 4696 W Overland Rd Ste 228, Boise, ID 83705-2864 | 2019-02-18 |
| 1215305263 | Cynthia Tremblay | Clinical Neuropsychologist | 600 N Robbins Rd, Boise, ID 83702-4565 | 2015-09-08 |
| 1154665123 | Merry Sylvester | Clinical Neuropsychologist | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2012-11-15 |
| 1659631562 | Brienne M Dyer | Clinical Neuropsychologist | 500 W Fort St, (b114), Boise, ID 83702-4501 | 2012-05-24 |
| 1275891194 | David E. Nilsson, Ph.d., P.C. | Clinical Neuropsychologist | 950 W Bannock St Ste 1100, Boise, ID 83702-6140 | 2012-04-28 |
| 1265677298 | Amy E. Latta, Ph.d., P.a. | Clinical Neuropsychologist | 1020 W Main St, Suite 100b, Boise, ID 83702-5789 | 2008-12-04 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.