MEDICARE: MRS. SUSANNA UTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	S2497	MS

General Provider Information

NPI Number	:	1023255270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSANNA UTZ

Provider Business Mailing Address
First Line	:	KAY JAMES DR
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0001
Country	:	US
Telephone Number	:	601-266-5223
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 COLLEGE DR # 10035
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39406-0002
Country	:	US
Telephone Number	:	601-266-5223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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Directions to “ MRS. SUSANNA UTZ ” Practice Location

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