Healthcare Provider Details

I. General information

NPI: 1861796245
Provider Name (Legal Business Name): JUANITA HUTCHINSON ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUANITA GREEN ED.D.

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WEST 15TH STREET # 509
CHICAGO IL
60605
US

IV. Provider business mailing address

61 WEST 15TH STREET # 509
CHICAGO IL
60605
US

V. Phone/Fax

Practice location:
  • Phone: 321-567-1290
  • Fax:
Mailing address:
  • Phone: 321-567-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: