Healthcare Provider Details

I. General information

NPI: 1558875732
Provider Name (Legal Business Name): ELIZA KATHLEEN HUTCHINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2017
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 GRAHAM ST
SAINT LOUIS MO
63139-3002
US

IV. Provider business mailing address

1518 GRAHAM ST
SAINT LOUIS MO
63139-3002
US

V. Phone/Fax

Practice location:
  • Phone: 314-541-7153
  • Fax:
Mailing address:
  • Phone: 314-541-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: