Healthcare Provider Details

I. General information

NPI: 1285020214
Provider Name (Legal Business Name): ANDREW KUTEMEIER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 ARTESIAN RD STE 112
NAPERVILLE IL
60564-8559
US

IV. Provider business mailing address

22205 W OCALA CT
PLAINFIELD IL
60544-7068
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone: 630-985-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014481
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: