Provider Demographics
NPI:1609499318
Name:GUTOWSKI, PAUL ANDREW
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:GUTOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-4146
Mailing Address - Country:US
Mailing Address - Phone:815-978-0979
Mailing Address - Fax:
Practice Address - Street 1:939 GALENA SQUARE DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1355
Practice Address - Country:US
Practice Address - Phone:815-777-1300
Practice Address - Fax:815-777-1308
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13846101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)