Healthcare Provider Details

I. General information

NPI: 1770333262
Provider Name (Legal Business Name): JESSICA HUTCHINSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 PENNRIDGE DR STE 119
BRIDGETON MO
63044-1244
US

IV. Provider business mailing address

4227 CARROLLTON DR APT B
BRIDGETON MO
63044-1990
US

V. Phone/Fax

Practice location:
  • Phone: 314-239-2728
  • Fax: 949-561-4148
Mailing address:
  • Phone: 314-600-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2023047238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: