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General NPI Number Information
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NPI Number | 1548505720
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Entity Type | Organization
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Legal Business Name | STATE UNIVERSITY OF IOWA
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 799 MAIN ST STE 230
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City | DUBUQUE
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State | IA
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Zip | 52001-6844
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Country | US
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Telephone | 563-382-1277
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Fax | 563-382-1287
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, PATIENT FINANCIAL SERVICE
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Name | PHILIP E ROUDABUSH
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Credential |
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Telephone | 319-353-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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