Healthcare Provider Details

I. General information

NPI: 1932148558
Provider Name (Legal Business Name): MARY HUTCHISON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 4 BOX 4515
PIEDMONT MO
63957-9417
US

IV. Provider business mailing address

RR 4 BOX 4515
PIEDMONT MO
63957-9417
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-4233
  • Fax: 573-223-2136
Mailing address:
  • Phone: 573-223-4233
  • Fax: 573-223-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: