Healthcare Provider Details

I. General information

NPI: 1356718092
Provider Name (Legal Business Name): MISS SIYI WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 18TH ST SW
CEDAR RAPIDS IA
52404-3303
US

IV. Provider business mailing address

725 EMERALD ST D24
IOWA CITY IA
52246-3048
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-1953
  • Fax:
Mailing address:
  • Phone: 319-400-9071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number079393
License Number StateIA

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: