Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 W 27TH ST 230 COMMUNICATION ARTS CENTER
CEDAR FALLS IA
50614-0356
US

IV. Provider business mailing address

1555 W 27TH ST 230 COMMUNICATION ARTS CENTER
CEDAR FALLS IA
50614-0356
US

V. Phone/Fax

Practice location:
  • Phone: 319-273-2542
  • Fax: 319-273-6384
Mailing address:
  • Phone: 319-273-2542
  • Fax: 319-273-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number115
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number00842
License Number StateIA

VIII. Authorized Official

Name: DR. THERESA KOURI
Title or Position: CLINIC DIRECTOR
Credential: PH.D.
Phone: 319-273-2542