Healthcare Provider Details

I. General information

NPI: 1154184059
Provider Name (Legal Business Name): MARIANNE WINIFRED HUTCHISON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANNE URBINA

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 N SEMINARY AVE
WOODSTOCK IL
60098-2626
US

IV. Provider business mailing address

2030 N SEMINARY AVE
WOODSTOCK IL
60098-2626
US

V. Phone/Fax

Practice location:
  • Phone: 815-679-4649
  • Fax:
Mailing address:
  • Phone: 815-679-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026435
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: