Provider Demographics
NPI:1760982813
Name:JOUETT, LOREN DREHER (CPO)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:DREHER
Last Name:JOUETT
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1S376 SUMMIT AVE
Mailing Address - Street 2:COURT E
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3985
Mailing Address - Country:US
Mailing Address - Phone:630-705-4092
Mailing Address - Fax:630-424-0467
Practice Address - Street 1:71 WAUKEGAN RD STE 400
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1634
Practice Address - Country:US
Practice Address - Phone:847-444-0690
Practice Address - Fax:847-444-0399
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000140222Z00000X
IL212000047224L00000X
IL211000079224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist