Provider Demographics
NPI:1558981126
Name:KUNTZ, MARIAH NICOLE (MA, CCC-SLP, CBIS)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:NICOLE
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 OAKDALE BLVD.
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9702
Mailing Address - Country:US
Mailing Address - Phone:319-351-5437
Mailing Address - Fax:319-351-5432
Practice Address - Street 1:2350 OAKDALE BLVD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9702
Practice Address - Country:US
Practice Address - Phone:319-351-5437
Practice Address - Fax:319-351-5432
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist