Provider Demographics
NPI:1407975261
Name:STATE UNIVERSITY OF IOWA
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:SEASHORE PSYCHOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL ASSOCIATE PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KE ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-335-2467
Mailing Address - Street 1:340 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1210
Mailing Address - Country:US
Mailing Address - Phone:319-335-2467
Mailing Address - Fax:319-353-2919
Practice Address - Street 1:335 E. JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-335-2467
Practice Address - Fax:319-353-2919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE UNIVERSITY OF IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA29078OtherPROVIDER NUMBER