Provider Demographics
NPI:1477675395
Name:UTLAUT, JONI DAWN (DT)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:DAWN
Last Name:UTLAUT
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULKEYTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62865-2631
Mailing Address - Country:US
Mailing Address - Phone:618-724-1026
Mailing Address - Fax:618-724-1026
Practice Address - Street 1:8724 MAIN ST
Practice Address - Street 2:
Practice Address - City:MULKEYTOWN
Practice Address - State:IL
Practice Address - Zip Code:62865-2631
Practice Address - Country:US
Practice Address - Phone:618-724-1026
Practice Address - Fax:618-724-1026
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist