Healthcare Provider Details

I. General information

NPI: 1093108300
Provider Name (Legal Business Name): ALLISON J HUTNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON J LIST LCSW

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 CAROLINE CT
VERNON HILLS IL
60061-4192
US

IV. Provider business mailing address

1219 CAROLINE CT
VERNON HILLS IL
60061-4192
US

V. Phone/Fax

Practice location:
  • Phone: 224-217-2435
  • Fax:
Mailing address:
  • Phone: 224-217-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149011237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: