Healthcare Provider Details

I. General information

NPI: 1881103471
Provider Name (Legal Business Name): COLLEGE PARK NEUROPSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 16TH ST NE STE 201
CEDAR RAPIDS IA
52402-4665
US

IV. Provider business mailing address

700 16TH ST NE STE 201
CEDAR RAPIDS IA
52402-4665
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-3935
  • Fax: 319-363-3448
Mailing address:
  • Phone: 319-365-3935
  • Fax: 319-363-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number00995
License Number StateIA

VIII. Authorized Official

Name: DR. ANGELA D PERKINS
Title or Position: OWNER
Credential: PSYD
Phone: 319-363-3935