Healthcare Provider Details

I. General information

NPI: 1356508220
Provider Name (Legal Business Name): MRS. JENNIFER HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E COURT ST
PARIS IL
61944-2210
US

IV. Provider business mailing address

PO BOX 1118 118 EAST COURT STREET
PARIS IL
61944-5118
US

V. Phone/Fax

Practice location:
  • Phone: 217-465-4115
  • Fax: 217-463-1899
Mailing address:
  • Phone: 217-465-4118
  • Fax: 217-463-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: