Healthcare Provider Details

I. General information

NPI: 1053750778
Provider Name (Legal Business Name): KRP THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2013
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 STAUB CT NE
CEDAR RAPIDS IA
52402-4029
US

IV. Provider business mailing address

1206 STAUB CT NE
CEDAR RAPIDS IA
52402-4029
US

V. Phone/Fax

Practice location:
  • Phone: 319-573-5467
  • Fax:
Mailing address:
  • Phone: 319-573-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06586
License Number StateIA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. KALLEEN RAGAN-PEPPER
Title or Position: THERAPIST/CEO
Credential: LISW
Phone: 319-573-5467