Healthcare Provider Details

I. General information

NPI: 1144278086
Provider Name (Legal Business Name): ROBERT RAYMOND HUTZELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W PLEASANT ST
KNOXVILLE IA
50138-3354
US

IV. Provider business mailing address

PO BOX 112
KNOXVILLE IA
50138-0112
US

V. Phone/Fax

Practice location:
  • Phone: 641-842-3101
  • Fax: 641-828-5307
Mailing address:
  • Phone: 641-842-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number245
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: