Provider Demographics
NPI:1689712549
Name:STATE UNIVERSITY OF IOWA
Entity Type:Organization
Organization Name:STATE UNIVERSITY OF IOWA
Other - Org Name:WENDELL JOHNSON SPEECH & HEARING CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL RECEPTIONIST BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-335-8703
Mailing Address - Street 1:250 HAWKINS DRIVE
Mailing Address - Street 2:THE UNIVERSITY OF IOWA
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1012
Mailing Address - Country:US
Mailing Address - Phone:319-335-8736
Mailing Address - Fax:319-335-8851
Practice Address - Street 1:250 HAWKINS DRIVE
Practice Address - Street 2:THE UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1012
Practice Address - Country:US
Practice Address - Phone:319-335-8736
Practice Address - Fax:319-335-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0099861Medicaid
IA01118OtherBLUE CROSS BLUE SHIELD OF