MEDICARE: DR. PATRICIA HUTH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-002753	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071-002753	OTHER	IL	PSYCHOLOGIST LICENSE
2	016-73036	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134139835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA HUTH PH.D.

Provider Business Mailing Address
First Line	:	720 LAKE ST
Second Line	:	SUITE202
City	:	OAK PARK
State	:	IL
Zip	:	60301-1424
Country	:	US
Telephone Number	:	708-848-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 LAKE ST
Second Line	:	SUITE202
City	:	OAK PARK
State	:	IL
Zip	:	60301-1424
Country	:	US
Telephone Number	:	708-848-0660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	04/28/2008

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