Healthcare Provider Details

I. General information

NPI: 1336298819
Provider Name (Legal Business Name): MARLA HUTCHINSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 S LAKESHORE DR
SAINT JOSEPH MI
49085-8277
US

IV. Provider business mailing address

2695 N TRAIL LN
SAINT JOSEPH MI
49085-3253
US

V. Phone/Fax

Practice location:
  • Phone: 269-235-0434
  • Fax:
Mailing address:
  • Phone: 269-429-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089570
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: