Healthcare Provider Details

I. General information

NPI: 1114662665
Provider Name (Legal Business Name): JULIA HUTCHINSON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 SELBY AVE
SAINT PAUL MN
55102-1728
US

IV. Provider business mailing address

521 2ND ST SE APT 301
MINNEAPOLIS MN
55414-2299
US

V. Phone/Fax

Practice location:
  • Phone: 612-877-1606
  • Fax:
Mailing address:
  • Phone: 612-877-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24463
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: