Healthcare Provider Details

I. General information

NPI: 1275986432
Provider Name (Legal Business Name): JADE HUTTER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PLEASANT ST
PARIS KY
40361-2035
US

IV. Provider business mailing address

320 PLEASANT ST
PARIS KY
40361-2035
US

V. Phone/Fax

Practice location:
  • Phone: 859-340-9119
  • Fax:
Mailing address:
  • Phone: 859-340-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7718
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: