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General NPI Number Information
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NPI Number | 1396810792
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Entity Type | Individual
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Provider Name | SHEILA KUTZ AUD., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 310 S 3RD ST
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City | GREENVILLE
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State | IL
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Zip | 62246-1733
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Country | US
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Telephone | 618-664-1146
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Fax | 618-664-4576
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Provider Business Mailing Address
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Address Line | 310 SOUTH 3RD STREET
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City | GREENVILLE
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State | IL
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Zip | 62246-1733
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Country | US
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Telephone | 618-664-1146
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Fax | 618-664-4576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147-00177
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License Number State | IL
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