Healthcare Provider Details

I. General information

NPI: 1558136739
Provider Name (Legal Business Name): RENEE N CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 OSBORN ST
BURLINGTON IA
52601-4551
US

IV. Provider business mailing address

1858 OSBORN
BURLINGTON IA
52601-3144
US

V. Phone/Fax

Practice location:
  • Phone: 563-316-2934
  • Fax:
Mailing address:
  • Phone: 563-316-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number887908
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0094567
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4546378
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5654786
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number857096
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number674569
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number659900
License Number StateIA
# 8
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number070657
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: