Healthcare Provider Details

I. General information

NPI: 1720904964
Provider Name (Legal Business Name): KATHRYN CHRISTINE PEITZ TCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 BOWLING ST SW STE C
CEDAR RAPIDS IA
52404-5070
US

IV. Provider business mailing address

5005 BOWLING ST SW STE C
CEDAR RAPIDS IA
52404-5070
US

V. Phone/Fax

Practice location:
  • Phone: 319-531-3824
  • Fax:
Mailing address:
  • Phone: 319-531-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT26028
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: