Healthcare Provider Details

I. General information

NPI: 1538609656
Provider Name (Legal Business Name): JENNIFER MAE HUTKOWSKI MSW, LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MAE PERRIN MSW, LLMSW

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 N. RIVER RD.
ST. CLAIR MI
48079-2803
US

IV. Provider business mailing address

P.O. BOX 183 1322 N. RIVER RD.
ST. CLAIR MI
48079-2803
US

V. Phone/Fax

Practice location:
  • Phone: 810-329-4798
  • Fax: 810-329-7303
Mailing address:
  • Phone: 810-329-4798
  • Fax: 810-329-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801100703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: