Provider Demographics
NPI:1073617676
Name:STOCKMAN, AMY (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STOCKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E WASHINGTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3909
Mailing Address - Country:US
Mailing Address - Phone:319-354-3232
Mailing Address - Fax:319-354-2990
Practice Address - Street 1:209 E WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3909
Practice Address - Country:US
Practice Address - Phone:319-354-3232
Practice Address - Fax:319-354-2990
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00790103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA01203OtherWELLMARK BCBS
IA01203OtherWELLMARK BCBS