MEDICARE: JEREMY CALEB KINSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	001350	IA

General Provider Information

NPI Number	:	1366675928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY CALEB KINSER

Provider Business Mailing Address
First Line	:	720 S DUBUQUE ST STE 1
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4242
Country	:	US
Telephone Number	:	319-214-0409
Fax Number	:	319-359-4144

Provider Business Practice Location Address
First Line	:	720 S DUBUQUE ST STE 1
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4242
Country	:	US
Telephone Number	:	319-214-0409
Fax Number	:	319-359-4144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	08/12/2019

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