Healthcare Provider Details

I. General information

NPI: 1285968230
Provider Name (Legal Business Name): NEREM NEUROPSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6165 NW 86TH ST
JOHNSTON IA
50131-2270
US

IV. Provider business mailing address

6165 NW 86TH ST
JOHNSTON IA
50131-2270
US

V. Phone/Fax

Practice location:
  • Phone: 515-727-1676
  • Fax: 515-727-1682
Mailing address:
  • Phone: 515-727-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number00918
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number00918
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number00918
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number00918
License Number StateIA

VIII. Authorized Official

Name: DR. DEANN LYN NEREM
Title or Position: DIRECTOR/CLINICAL NEUROPSYCHOLOGIST
Credential: PSYD
Phone: 515-689-6411