Healthcare Provider Details

I. General information

NPI: 1801921465
Provider Name (Legal Business Name): LAURA WICKENS HUTCHISON PSY.D, LLP, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38345 W 10 MILE RD STE 150
FARMINGTON HILLS MI
48335-2867
US

IV. Provider business mailing address

38345 WEST TEN MILE RD STE 150
FARMINGTON HILLS MI
48335
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-5754
  • Fax: 248-478-0435
Mailing address:
  • Phone: 248-788-5754
  • Fax: 248-478-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013109
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: