Healthcare Provider Details

I. General information

NPI: 1235049925
Provider Name (Legal Business Name): CORRIDOR KIDS COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 HIGHWAY 1 W
IOWA CITY IA
52246-4205
US

IV. Provider business mailing address

528 BLUESTEM ST
TIFFIN IA
52340-5200
US

V. Phone/Fax

Practice location:
  • Phone: 319-244-8236
  • Fax:
Mailing address:
  • Phone: 319-244-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNY LYNN DAVIS
Title or Position: OWNER, CEO
Credential: BCBA/LBA
Phone: 319-244-8236