Provider Demographics
NPI:1598736241
Name:STATE UNIVERSITY OF IOWA
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:BELIN-BLANK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED SENIOR STAFF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY NICPON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-335-6148
Mailing Address - Street 1:600 BLANK HONORS CENTER
Mailing Address - Street 2:THE UNIVERSITY OF IOWA
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-0454
Mailing Address - Country:US
Mailing Address - Phone:319-335-6148
Mailing Address - Fax:319-335-5151
Practice Address - Street 1:600 BLANK HONORS CENTER
Practice Address - Street 2:THE UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-0454
Practice Address - Country:US
Practice Address - Phone:319-335-6148
Practice Address - Fax:319-335-5151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE UNIVERSITY OF IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-31
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00980103G00000X, 103T00000X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923Medicare PIN