Healthcare Provider Details

I. General information

NPI: 1841818580
Provider Name (Legal Business Name): JOHN COUTRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N FARNSWORTH AVE
AURORA IL
60505-1523
US

IV. Provider business mailing address

424 W MADISON ST
OTTAWA IL
61350-2833
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-6303
  • Fax: 815-433-3980
Mailing address:
  • Phone: 815-433-3953
  • Fax: 815-433-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: