Provider Demographics
NPI:1285071712
Name:STUTZ, RISA (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:STUTZ
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1701
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-7901
Mailing Address - Country:US
Mailing Address - Phone:270-210-9280
Mailing Address - Fax:
Practice Address - Street 1:1301 ENTERPRISE WAY STE 44
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4442
Practice Address - Country:US
Practice Address - Phone:270-210-9280
Practice Address - Fax:270-210-9280
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0172371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical