Healthcare Provider Details

I. General information

NPI: 1932981677
Provider Name (Legal Business Name): CARLA MARY HUTCHINSON-WILLETT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 S BUCKSKIN PASS DR
COLORADO SPRINGS CO
80917-2757
US

IV. Provider business mailing address

5720 S BUCKSKIN PASS DR
COLORADO SPRINGS CO
80917-2757
US

V. Phone/Fax

Practice location:
  • Phone: 719-659-7059
  • Fax:
Mailing address:
  • Phone: 719-659-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009922876
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: