Provider Demographics
NPI:1346239282
Name:ULTZ, ROXANNE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:ULTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-3220
Mailing Address - Country:US
Mailing Address - Phone:574-232-2255
Mailing Address - Fax:574-232-8968
Practice Address - Street 1:500 N NAPPANEE ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1503
Practice Address - Country:US
Practice Address - Phone:574-522-8992
Practice Address - Fax:574-293-2429
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical