Provider Demographics
NPI:1164428496
Name:KONTZ, GINA LOUISE (MA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LOUISE
Last Name:KONTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N 1ST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-4551
Mailing Address - Country:US
Mailing Address - Phone:320-321-1551
Mailing Address - Fax:320-321-1552
Practice Address - Street 1:408 N 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265
Practice Address - Country:US
Practice Address - Phone:320-321-1551
Practice Address - Fax:320-321-1552
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6279237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4500108OtherUNITED HEALTH CARE PROV #
SD5832630Medicaid
MN1024676OtherPREFERRED ONE PROV. NUMBE
MN45-00108OtherMEDICA PROVIDER NUMBER
MN031021002Medicaid
MN09339WIOtherBCBS PROVIDER NUMBER
MN39P72WIOtherGINA'S TESTING FOR BCBS
MN41-1603792001OtherTRICARE WEST PROV. NUMBER
MN568819100Medicaid
MN117072Medicaid
MN41-1603792001OtherTRICARE WEST PROV. NUMBER
MN45-00108OtherMEDICA PROVIDER NUMBER