Provider Demographics
NPI:1710046875
Name:EXCEPTIONAL PERSONS, INC
Entity Type:Organization
Organization Name:EXCEPTIONAL PERSONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS AFFAIRS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNGLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-232-6671
Mailing Address - Street 1:PO BOX 4090
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-4090
Mailing Address - Country:US
Mailing Address - Phone:319-232-6671
Mailing Address - Fax:
Practice Address - Street 1:760 ANSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5714
Practice Address - Country:US
Practice Address - Phone:319-232-6671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0244632Medicaid