Provider Demographics
NPI:1225217722
Name:ROTZ, LEE A (MA CCC-A, FAAA)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:A
Last Name:ROTZ
Suffix:
Gender:F
Credentials:MA CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-326-8630
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-4375
Practice Address - Fax:217-326-2336
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000507231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4117OtherHAMP PROVIDER #
IL7216OtherPERSONALCARE
IL113326OtherHEALTHLINK
IL203OtherBLUE CROSS
IL7216OtherPERSONALCARE