Healthcare Provider Details

I. General information

NPI: 1982227971
Provider Name (Legal Business Name): JESSE HUTCHISON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 10/19/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 BISHOP ST STE 929
HONOLULU HI
96813
US

IV. Provider business mailing address

1164 BISHOP ST STE 929
HONOLULU HI
96813-2882
US

V. Phone/Fax

Practice location:
  • Phone: 808-977-6210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1808
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: