DR. JAMIE C. DERRICK (NPI# 1871792697) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871792697 |
| Entity Type | Individual |
| Full Name | DR. JAMIE C. DERRICK |
| Other Name | DR. JAMIE C. NEKICH |
| Credential | PH.D. |
| Practice Address |
875 Perimeter Dr Dept. of Psychology, University of Idaho, Ms 3043 Moscow ID 83844-9803 |
| Mailing Address |
875 Perimeter Dr University of Idaho, Ms 3043 (psychology Dept) Moscow ID 83844-3043 |
| Practice Telephone | 2088855057 |
| Mailing Telephone | 2088855057 |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2014-01-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | PSY14487 | CA | Behavioral Health & Social Service Providers |
| Y | 103T00000X | Psychologist | PSY325 | ID | Behavioral Health & Social Service Providers |
| Street Address |
875 PERIMETER DR DEPT. OF PSYCHOLOGY, UNIVERSITY OF IDAHO, MS 3043 |
| City | MOSCOW |
| State | ID |
| Zip Code | 83844-9803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821024233 | Ryan Tobias Van Amerongen | Specialist/Technologist | 875 Perimeter Dr, Ms:2302, Moscow, ID 83844-2302 | 2006-06-25 |
| 1902423148 | Angelica Torres Luna | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2020-07-04 |
| 1700403938 | Stephen Michael Panteleakos | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2020-07-03 |
| 1982228573 | Amanda Chiou | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2020-05-30 |
| 1083238679 | Isabella Adrianna Hernandez | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2020-05-30 |
| 1487207072 | Mitchell Allen Collar | Student in an Organized Health Care Education/Training Program | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2019-07-22 |
| 1033770029 | Logan Frederick Prins | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2019-06-21 |
| 1417518408 | Kassandra Johnson | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2019-06-21 |
| 1023678026 | Natsumi Kuribayashi | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2019-06-20 |
| 1619441540 | Ashlie Lynn Randall | Specialist/Technologist | 875 Perimeter Dr, Moscow, ID 83844-9803 | 2019-01-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578118568 | Rechelle Ann Meade | Specialist/Technologist | 875 Perimeter Drive, Moscow, ID 83844 | 2019-08-06 |
| 1720618960 | Samantha Layne Hanna | Specialist/Technologist | 875 Perimeter Drive College of Education 123, Moscow, ID 83844-0001 | 2020-01-15 |
| 1649764713 | Clarissa Marie Edge Richardson | Psychologist | University of Idaho Student Health Center 210, Moscow, ID 83844-0001 | 2018-06-21 |
| 1588193577 | Carmen Perez | Specialist/Technologist | University of Idaho 709 South Deakin St, Moscow, ID 83844-0001 | 2017-06-05 |
| 1013445220 | Alec Webbenhurst | Specialist/Technologist | University of Idaho Athletic Training 875 Dr, Moscow, ID 83844-0001 | 2017-06-01 |
| 1194990044 | William A. Cone | Psychiatry & Neurology | 831 Ash St, Moscow, ID 83844-0001 | 2008-04-22 |
| 1467855403 | Clint Emmett | Nurse Practitioner | 875 Perimeter Dr # Ms 3140, Moscow, ID 83844-2006 | 2014-10-06 |
| 1922529544 | Christopher John Walsh Jr. | Specialist/Technologist | University of Idaho Athletic Training Services, 1000 Stadium Way, Moscow, ID 83844-2302 | 2017-07-05 |
| 1700284262 | Megan Renae Shifflett | Specialist/Technologist | 875 Perimeter Dr # Ms 2302, Moscow, ID 83844-2302 | 2014-12-16 |
| 1013044767 | Megan Brooke Borchert | Specialist/Technologist | 442302 Asui Kibbie Dome, Moscow, ID 83844-2302 | 2007-02-28 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902932262 | Laura C Richards | Psychologist | 129 W 3rd St, Moscow, ID 83843-2268 | 2007-02-23 |
| 1134264880 | Sharon Elayne Volansky Gerard | Psychologist | 515 Moscow Road, Moscow, VT 05662 | 2007-02-20 |
| 1992885735 | Martha A Kitzrow | Psychologist | 106 E 3rd St Ste 6, Moscow, ID 83843-2970 | 2006-10-16 |
| 1881699536 | Beth Waddel | Psychologist | 814 S Washington St, Moscow, ID 83843-3049 | 2005-06-18 |
| 1225155575 | Timothy Scott Rehnberg | Psychologist | 2301 W A St, Suite C, Moscow, ID 83843-4042 | 2007-03-23 |
| 1255423745 | Brian William Mcneill | Psychologist | 619 S Washington, Suite 301 Brian Mcneill Phd, Moscow, ID 83843 | 2006-09-29 |
| 1336249952 | Susan L. Simonds | Psychologist | 619 S Washington St, Suite 301, Moscow, ID 83843-3090 | 2006-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841815164 | Amanda Catherine Kearns | Psychologist | 1612 Kearney St, Idaho Falls, ID 83401-3055 | 2020-06-11 |
| 1457813719 | Natasha Megan Quinn | Psychologist | 500 W Fort St Bldg 114, Boise, ID 83702-4501 | 2019-04-04 |
| 1164996468 | Stephanie Elizabeth Stacy | Psychologist | 500 W Fort St Bldg 23, Boise, ID 83702-4501 | 2019-01-20 |
| 1720559248 | Kathleen M Moore | Psychologist | 918 Cattail Ct, Sandpoint, ID 83864-5094 | 2018-12-10 |
| 1427534395 | Hanna S Thomas | Psychologist | 1200 N Liberty St, Boise, ID 83704-8742 | 2018-07-13 |
| 1699120394 | Cady Williams | Psychologist | 3344 N 375 E, Rexburg, ID 83440-3437 | 2016-04-30 |
| 1477927846 | Grey Psychology Associates, Pllc | Psychologist | 1821 E Sherman Ave, Coeur D Alene, ID 83814-5352 | 2015-11-21 |
| 1508264995 | Gary L. Grogan | Psychologist | 633 Main Street, B#1, Lewiston, ID 83501 | 2014-12-17 |
| 1912332446 | Quality Care Counseling Center Inc. | Psychologist | 2316 N. Cole Rd, Suite A, Boise, ID 83704 | 2013-09-03 |
| 1386986412 | Jennifer Lee Henderson | Psychologist | 111 E. 16th Street, Innovative Health Care Concepts Inc., Idaho Falls, ID 83401 | 2013-03-27 |
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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.