Healthcare Provider Details

I. General information

NPI: 1790111409
Provider Name (Legal Business Name): JANE ELLEN HUTCHINSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BRANDYWINE BLVD
FAYETTEVILLE GA
30214-1560
US

IV. Provider business mailing address

120 HIDDEN LAKE DR
FAYETTEVILLE GA
30215-8138
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-0165
  • Fax:
Mailing address:
  • Phone: 330-351-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP007909
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP10446
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: