Healthcare Provider Details

I. General information

NPI: 1780693994
Provider Name (Legal Business Name): REBECCA SUE MANNETTER PHD, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-6507
US

IV. Provider business mailing address

1519 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-6507
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-9939
  • Fax:
Mailing address:
  • Phone: 319-365-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberT058065
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: