Healthcare Provider Details

I. General information

NPI: 1750347670
Provider Name (Legal Business Name): TERRI HUTTON RN, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8629 BLUEJACKET ST SUITE 102
LENEXA KS
66214-1604
US

IV. Provider business mailing address

PO BOX 674
SHAWNEE MISSION KS
66201-0674
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-0500
  • Fax: 913-677-5243
Mailing address:
  • Phone: 913-248-9693
  • Fax: 913-248-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSCSW-1963
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: