Provider Demographics
NPI:1740363753
Name:STUTESMAN, JOHN ROLFE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROLFE
Last Name:STUTESMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W FRY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5418
Mailing Address - Country:US
Mailing Address - Phone:312-802-1500
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 2130
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6747
Practice Address - Country:US
Practice Address - Phone:312-802-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical