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General NPI Number Information
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NPI Number | 1881103471
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Entity Type | Organization
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Legal Business Name | COLLEGE PARK NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 700 16TH ST NE STE 201
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-4665
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Country | US
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Telephone | 319-365-3935
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Fax | 319-363-3448
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Provider Business Mailing Address
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Address Line | 700 16TH ST NE STE 201
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-4665
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Country | US
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Telephone | 319-365-3935
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Fax | 319-363-3448
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELA D PERKINS
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Credential | PSYD
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Telephone | 319-363-3935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 00995
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License Number State | IA
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