Healthcare Provider Details

I. General information

NPI: 1396810792
Provider Name (Legal Business Name): SHEILA KUTZ AUD., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S 3RD ST
GREENVILLE IL
62246-1733
US

IV. Provider business mailing address

310 SOUTH 3RD STREET
GREENVILLE IL
62246-1733
US

V. Phone/Fax

Practice location:
  • Phone: 618-664-1146
  • Fax: 618-664-4576
Mailing address:
  • Phone: 618-664-1146
  • Fax: 618-664-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-00177
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: