Provider Demographics
NPI:1801192927
Name:DESUTTER, ERIN S
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:DESUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1203
Mailing Address - Country:US
Mailing Address - Phone:815-626-7333
Mailing Address - Fax:815-626-8752
Practice Address - Street 1:1901 FIRST AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1203
Practice Address - Country:US
Practice Address - Phone:815-626-7333
Practice Address - Fax:815-626-8752
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006005101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor