Provider Demographics
NPI:1275685042
Name:UTZ, PATRICK W (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
Last Name:UTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50835 LINCOLNSHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9027
Mailing Address - Country:US
Mailing Address - Phone:574-272-9272
Mailing Address - Fax:574-273-2839
Practice Address - Street 1:50835 LINCOLNSHIRE TRL
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9027
Practice Address - Country:US
Practice Address - Phone:574-272-9272
Practice Address - Fax:574-273-2839
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090159A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist