Healthcare Provider Details

I. General information

NPI: 1558794271
Provider Name (Legal Business Name): JODY LEE HUTSELL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 56TH ST BLDG A
KEARNEY NE
68847-8628
US

IV. Provider business mailing address

920 E 56TH ST BLDG A
KEARNEY NE
68847-8628
US

V. Phone/Fax

Practice location:
  • Phone: 308-233-5060
  • Fax: 308-233-5062
Mailing address:
  • Phone: 308-233-5060
  • Fax: 308-233-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1599
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: