MEDICARE: DR. AMY CARROLL COLLINS PHD

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	01005	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26854	OTHER	IA	WELLMARK PROVIDER #

General Provider Information

NPI Number	:	1710067301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY CARROLL COLLINS PHD

Provider Business Mailing Address
First Line	:	1101 5TH ST STE 102
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2904
Country	:	US
Telephone Number	:	319-351-9777
Fax Number	:	319-351-9991

Provider Business Practice Location Address
First Line	:	1101 5TH ST
Second Line	:	STE 102
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2903
Country	:	US
Telephone Number	:	319-351-9777
Fax Number	:	319-351-9991

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/07/2025

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