Provider Demographics
NPI:1922601772
Name:UTESCH, LORI LYN (BS)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYN
Last Name:UTESCH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7044
Mailing Address - Country:US
Mailing Address - Phone:219-314-8478
Mailing Address - Fax:
Practice Address - Street 1:1308 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2719
Practice Address - Country:US
Practice Address - Phone:219-663-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health