=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922883552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE ANNE CATON FREY LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2023
-----------------------------------------------------
Last Update Date | 10/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 E COLLEGE ST LOWR LEVEL
-----------------------------------------------------
City | IOWA CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52240-5114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-208-2592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1409 N AVE NW
-----------------------------------------------------
City | CEDAR RAPIDS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52405-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-329-5930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 114043
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------