Provider Demographics
NPI:1720578982
Name:BANTZ, STEVEN M (LISW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:BANTZ
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 SULLIVAN SLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9013
Mailing Address - Country:US
Mailing Address - Phone:319-752-4000
Mailing Address - Fax:319-752-6933
Practice Address - Street 1:4717 SULLIVAN SLOUGH RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9013
Practice Address - Country:US
Practice Address - Phone:319-752-4000
Practice Address - Fax:319-752-6933
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health