Provider Demographics
NPI:1063470060
Name:GREEN, ANNE M (PH D)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:GREEN-EMRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PH D
Mailing Address - Street 1:2000 JAMES ST.
Mailing Address - Street 2:STE 211
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1882
Mailing Address - Country:US
Mailing Address - Phone:319-358-9397
Mailing Address - Fax:
Practice Address - Street 1:2000 JAMES ST.
Practice Address - Street 2:STE 211
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1882
Practice Address - Country:US
Practice Address - Phone:319-358-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA627103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54265OtherWELLMARK
IA54265Medicare ID - Type Unspecified