Provider Demographics
NPI:1366675928
Name:KINSER, JEREMY CALEB
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:CALEB
Last Name:KINSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S DUBUQUE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4242
Mailing Address - Country:US
Mailing Address - Phone:319-214-0409
Mailing Address - Fax:319-359-4144
Practice Address - Street 1:720 S DUBUQUE ST STE 1
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4242
Practice Address - Country:US
Practice Address - Phone:319-214-0409
Practice Address - Fax:319-359-4144
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001350103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling