Healthcare Provider Details

I. General information

NPI: 1437567831
Provider Name (Legal Business Name): STEPHANIE GUTZMER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SALT CREEK LN STE 101
HINSDALE IL
60521-2990
US

IV. Provider business mailing address

11 SALT CREEK LN SUITE 101
HINSDALE IL
60521-2990
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-3110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147001511
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001511
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: