Provider Demographics
NPI:1326354127
Name:LINDA COLLINS PHD PC
Entity Type:Organization
Organization Name:LINDA COLLINS PHD PC
Other - Org Name:CEDAR RAPIDS MEMORY CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-447-1395
Mailing Address - Street 1:216 NORTHLAND CT NE STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6226
Mailing Address - Country:US
Mailing Address - Phone:319-447-1395
Mailing Address - Fax:
Practice Address - Street 1:216 NORTHLAND CT NE STE A
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6226
Practice Address - Country:US
Practice Address - Phone:319-447-1395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00930103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty