Healthcare Provider Details

I. General information

NPI: 1770941551
Provider Name (Legal Business Name): SHANA KUTSCH M.A. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 DODGE ST STE D4
DUBUQUE IA
52003-7161
US

IV. Provider business mailing address

2600 DODGE ST STE D4
DUBUQUE IA
52003-7161
US

V. Phone/Fax

Practice location:
  • Phone: 563-663-0670
  • Fax:
Mailing address:
  • Phone: 563-663-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number080947
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: