Healthcare Provider Details

I. General information

NPI: 1093795254
Provider Name (Legal Business Name): RICHARD ARTHUR HUTCHISON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 01/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 16TH ST
MOLINE IL
61265-7217
US

IV. Provider business mailing address

PO BOX 86
MOLINE IL
61266-0086
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-6979
  • Fax: 309-797-6986
Mailing address:
  • Phone: 309-797-6979
  • Fax: 309-797-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-003249
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00511
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: