Healthcare Provider Details

I. General information

NPI: 1164420113
Provider Name (Legal Business Name): JENNIFER MARIE HUTCHISON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 HOSPITAL DR SUITE 200
GLEN BURNIE MD
21061-6904
US

IV. Provider business mailing address

203 HOSPITAL DR SUITE 200
GLEN BURNIE MD
21061-6904
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8840
  • Fax:
Mailing address:
  • Phone: 410-760-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: