Healthcare Provider Details

I. General information

NPI: 1134139835
Provider Name (Legal Business Name): PATRICIA HUTH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 LAKE ST SUITE202
OAK PARK IL
60301-1424
US

IV. Provider business mailing address

720 LAKE ST SUITE202
OAK PARK IL
60301-1424
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-0660
  • Fax:
Mailing address:
  • Phone: 708-848-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-002753
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: