Healthcare Provider Details

I. General information

NPI: 1093339863
Provider Name (Legal Business Name): TAALOR RENE BRODIGAN M.S.ED., LMHC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 500
CEDAR RAPIDS IA
52402-3221
US

IV. Provider business mailing address

4403 1ST AVE SE STE 500
CEDAR RAPIDS IA
52402-3221
US

V. Phone/Fax

Practice location:
  • Phone: 319-200-5670
  • Fax:
Mailing address:
  • Phone: 319-200-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: