Healthcare Provider Details

I. General information

NPI: 1669910691
Provider Name (Legal Business Name): JESSICA L HUTCHISON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W OLD NORTHWEST HWY STE 200
BARRINGTON IL
60010-6816
US

IV. Provider business mailing address

509 W OLD NORTHWEST HWY STE 200
BARRINGTON IL
60010-6816
US

V. Phone/Fax

Practice location:
  • Phone: 224-655-8718
  • Fax:
Mailing address:
  • Phone: 224-655-8718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180009132
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: