Healthcare Provider Details

I. General information

NPI: 1013777853
Provider Name (Legal Business Name): JILLIAN KELLEY HUTTO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W THARPE ST STE 7
TALLAHASSEE FL
32303-5300
US

IV. Provider business mailing address

728 OLD BUMPY RD
TALLAHASSEE FL
32317-8689
US

V. Phone/Fax

Practice location:
  • Phone: 850-561-1143
  • Fax:
Mailing address:
  • Phone: 850-545-0561
  • 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: