Healthcare Provider Details

I. General information

NPI: 1457422685
Provider Name (Legal Business Name): PATRICIA ANN KUTYNA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 S 4TH ST UNIT 1
PEKIN IL
61554-4266
US

IV. Provider business mailing address

6 S 4TH ST UNIT 1
PEKIN IL
61554-4266
US

V. Phone/Fax

Practice location:
  • Phone: 309-346-2877
  • Fax: 309-346-7663
Mailing address:
  • Phone: 309-346-2877
  • Fax: 309-346-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: