Healthcare Provider Details

I. General information

NPI: 1801176201
Provider Name (Legal Business Name): SHAYLE MICHELLE HUTCHISON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 S CUSHMAN ST
FAIRBANKS AK
99701-7530
US

IV. Provider business mailing address

PO BOX 70672
FAIRBANKS AK
99707-0672
US

V. Phone/Fax

Practice location:
  • Phone: 907-455-1416
  • Fax: 907-455-1487
Mailing address:
  • Phone: 907-328-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: