Provider Demographics
NPI:1174882245
Name:POTUZNIK, SYNTHIA ANN (CERTIFIED HEARING IN)
Entity type:Individual
Prefix:MS
First Name:SYNTHIA
Middle Name:ANN
Last Name:POTUZNIK
Suffix:
Gender:F
Credentials:CERTIFIED HEARING IN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 TOWNLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-362-2669
Mailing Address - Fax:608-362-2669
Practice Address - Street 1:1327 TOWNLINE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-362-2669
Practice Address - Fax:608-362-2669
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI864-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI864-60OtherCERTIFIED HEARING INSTRUMENT SPECIALIST