Provider Demographics
NPI:1144319344
Name:LENZ, CONNIE L (AUD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:L
Last Name:LENZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9305
Mailing Address - Country:US
Mailing Address - Phone:319-364-3322
Mailing Address - Fax:319-362-2422
Practice Address - Street 1:1953 1ST AVE SE
Practice Address - Street 2:STE B2
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5328
Practice Address - Country:US
Practice Address - Phone:319-364-3322
Practice Address - Fax:319-362-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA298237600000X
IA506237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA99971OtherBCBS OF IOWA
IA99893OtherBLUE CROSS BLUE SHIELD
IAF234880OtherMIDLAND'S CHOICE
IA3061911Medicaid
IA3061911Medicaid