Provider Demographics
NPI:1316916117
Name:KUNTZ, LORI (LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1176
Mailing Address - Country:US
Mailing Address - Phone:608-935-2838
Mailing Address - Fax:608-935-9227
Practice Address - Street 1:1118 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1176
Practice Address - Country:US
Practice Address - Phone:608-935-2838
Practice Address - Fax:608-935-9227
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2962-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical