Provider Demographics
NPI:1235466301
Name:UNIVERSITY OF NORTHERN IOWA ROY EBLEN SPEECH AND HEARING CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTHERN IOWA ROY EBLEN SPEECH AND HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-273-2542
Mailing Address - Street 1:1555 W 27TH ST
Mailing Address - Street 2:230 COMMUNICATION ARTS CENTER
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0356
Mailing Address - Country:US
Mailing Address - Phone:319-273-2542
Mailing Address - Fax:319-273-6384
Practice Address - Street 1:1555 W 27TH ST
Practice Address - Street 2:230 COMMUNICATION ARTS CENTER
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0356
Practice Address - Country:US
Practice Address - Phone:319-273-2542
Practice Address - Fax:319-273-6384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTHERN IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115231H00000X
IA00842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty