| Jonathan Backstrom, Llc | |
|
2625 W 36th St Davenport IA 52806-5224 | |
| (563) 650-5863 | |
| Not Available |
| Full Name | Jonathan Backstrom, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2625 W 36th St, Davenport, Iowa |
| Authorized Official Name and Position | Jon Backstrom (THERAPIST) |
| Authorized Official Contact | 5636505863 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan Backstrom, Llc 2625 W 36th St Davenport IA 52806-5224 Ph: (563) 650-5863 | Jonathan Backstrom, Llc 2625 W 36th St Davenport IA 52806-5224 Ph: (563) 650-5863 |
| NPI Number | 1356932073 |
|---|---|
| Provider Enumeration Date | 01/27/2021 |
| Last Update Date | 01/27/2021 |
| Certification Date | 01/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356932073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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