Provider Demographics
NPI:1437446200
Name:DUTENHOFFER, NEIL (HIS)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:DUTENHOFFER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 2ND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3507
Mailing Address - Country:US
Mailing Address - Phone:308-224-2072
Mailing Address - Fax:402-387-7172
Practice Address - Street 1:3000 2ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3507
Practice Address - Country:US
Practice Address - Phone:308-224-2072
Practice Address - Fax:402-387-7172
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE753237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist