Healthcare Provider Details

I. General information

NPI: 1568918365
Provider Name (Legal Business Name): KATHLEEN HUTTNER BA MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W. DEMPSER KENNETH YOUNG CENTER
MOUNT PROSPECT IL
60056
US

IV. Provider business mailing address

811 S DWYER AVE UNIT E
ARLINGTON HEIGHTS IL
60005-5421
US

V. Phone/Fax

Practice location:
  • Phone: 847-621-2040
  • Fax:
Mailing address:
  • Phone: 773-879-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: