Provider Demographics
NPI:1558136739
Name:CRUZ, RENEE N
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:N
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4244
Mailing Address - Country:US
Mailing Address - Phone:319-759-9091
Mailing Address - Fax:
Practice Address - Street 1:120 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4244
Practice Address - Country:US
Practice Address - Phone:319-759-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4546378103T00000X
IA009456101Y00000X
103T00000X
IA674569103TF0000X
IA070657202D00000X
IA659900106H00000X
IA5654786103TB0200X
IA857096103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1558136789Medicaid