Provider Demographics
NPI:1396810792
Name:KUTZ, SHEILA (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:KUTZ
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SOUTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1733
Mailing Address - Country:US
Mailing Address - Phone:618-664-1146
Mailing Address - Fax:618-664-4576
Practice Address - Street 1:310 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1733
Practice Address - Country:US
Practice Address - Phone:618-664-1146
Practice Address - Fax:618-664-4576
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-00177231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000332001OtherBLUECROSS BLUESHIELD
IL4500135OtherUNITED HEALTHCARE
IL478224OtherHEALTHLINK INSURANCE
IL4500135OtherUNITED HEALTHCARE