Provider Demographics
NPI:1437042470
Name:LANTZ, NIKO LOUISE (LSW)
Entity type:Individual
Prefix:MS
First Name:NIKO
Middle Name:LOUISE
Last Name:LANTZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:NIKO
Other - Middle Name:LOUISE
Other - Last Name:REIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:16705 ROUTE 89
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-8713
Mailing Address - Country:US
Mailing Address - Phone:814-392-5332
Mailing Address - Fax:
Practice Address - Street 1:398 W BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1369
Practice Address - Country:US
Practice Address - Phone:216-282-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1427501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical