Provider Demographics
NPI:1730240680
Name:COLLISON-GOOD, KATHLEEN E (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:COLLISON-GOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:101 2ND ST SE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1219
Mailing Address - Country:US
Mailing Address - Phone:319-364-8741
Mailing Address - Fax:319-368-8096
Practice Address - Street 1:101 2ND ST SE
Practice Address - Street 2:SUITE 700
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1219
Practice Address - Country:US
Practice Address - Phone:319-364-8741
Practice Address - Fax:319-368-8096
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03521Medicare ID - Type Unspecified