Provider Demographics
NPI:1205943875
Name:UNTZ, BARBARA ROSE (OSFMS)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ROSE
Last Name:UNTZ
Suffix:
Gender:F
Credentials:OSFMS
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:D'ARC UNTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OSF-MS
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0361
Mailing Address - Country:US
Mailing Address - Phone:563-242-5316
Mailing Address - Fax:563-242-3128
Practice Address - Street 1:562 N BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732
Practice Address - Country:US
Practice Address - Phone:563-242-4070
Practice Address - Fax:563-242-2426
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F238375OtherMIDLANDS CHOICE
IA0665265Medicaid
IA71076OtherWELLMARK BCBS OF IOWA
42137277103OtherJOHN DEERE HEALTH
42137277103OtherJOHN DEERE HEALTH
IA166526Medicare Oscar/Certification