Healthcare Provider Details

I. General information

NPI: 1801521406
Provider Name (Legal Business Name): EMILY BRENNY KROSKA THOMAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY BRENNY KROSKA PHD

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E. JEFFERSON ST.
IOWA CITY IA
52242
US

IV. Provider business mailing address

340 IOWA AVENUE G60 PBSB
IOWA CITY IA
52242
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-2467
  • Fax:
Mailing address:
  • Phone: 319-467-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number097080
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number097020
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: