Healthcare Provider Details

I. General information

NPI: 1679302608
Provider Name (Legal Business Name): TWO RIVERS NEUROPSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 100TH ST STE 3
URBANDALE IA
50322-5505
US

IV. Provider business mailing address

4700 78TH ST
URBANDALE IA
50322-1031
US

V. Phone/Fax

Practice location:
  • Phone: 515-220-2747
  • Fax: 515-335-0247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL RIVERS
Title or Position: MEMBER/ CLINICAL NEUROPSYCHOLOGIST
Credential: PHD, LP
Phone: 515-220-2747