Provider Demographics
NPI:1184016289
Name:GUTZMANN, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GUTZMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 S 145TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3201
Mailing Address - Country:US
Mailing Address - Phone:402-206-5033
Mailing Address - Fax:712-732-3775
Practice Address - Street 1:107 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2343
Practice Address - Country:US
Practice Address - Phone:712-732-3775
Practice Address - Fax:712-732-3775
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072944237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist