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General NPI Number Information
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NPI Number | 1356705495
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Entity Type | Organization
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Legal Business Name | IOWA CITY PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 2225 MORMON TREK BLVD SUITE 205
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City | IOWA CITY
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State | IA
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Zip | 52246-4407
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Country | US
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Telephone | 319-538-8782
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 MORMON TREK BLVD SUITE 205
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City | IOWA CITY
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State | IA
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Zip | 52246-4407
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Country | US
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Telephone | 319-538-8782
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. CARRIE ANN KIMPTON HEALD
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Credential | PHD
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Telephone | 319-538-8782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 001247
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License Number State | IA
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