MEDICARE: UNIVERSITY OF NORTHERN IOWA ROY EBLEN SPEECH AND HEARING CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	00842	IA
2	231H00000X	Audiologist	115	IA

General Provider Information

NPI Number	:	1235466301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF NORTHERN IOWA ROY EBLEN SPEECH AND HEARING CLINIC

Provider Business Mailing Address
First Line	:	1555 W 27TH ST
Second Line	:	230 COMMUNICATION ARTS CENTER
City	:	CEDAR FALLS
State	:	IA
Zip	:	50614-0356
Country	:	US
Telephone Number	:	319-273-2542
Fax Number	:	319-273-6384

Provider Business Practice Location Address
First Line	:	1555 W 27TH ST
Second Line	:	230 COMMUNICATION ARTS CENTER
City	:	CEDAR FALLS
State	:	IA
Zip	:	50614-0356
Country	:	US
Telephone Number	:	319-273-2542
Fax Number	:	319-273-6384

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. THERESA KOURI
Credential	:	PH.D.
Telephone Number	:	319-273-2542

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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