Provider Demographics
NPI:1962299859
Name:KIMREY, RILEY THOMPSON (IADC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:THOMPSON
Last Name:KIMREY
Suffix:
Gender:
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 AURORA AVE STE 400W
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2868
Mailing Address - Country:US
Mailing Address - Phone:515-537-2965
Mailing Address - Fax:515-537-2965
Practice Address - Street 1:6200 AURORA AVE STE 400W
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2868
Practice Address - Country:US
Practice Address - Phone:515-537-2965
Practice Address - Fax:515-537-2965
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25R504101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)