Healthcare Provider Details

I. General information

NPI: 1558970293
Provider Name (Legal Business Name): KRISTIN HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 S 7TH ST
IRONTON OH
45638-2538
US

IV. Provider business mailing address

31 EAST ST
PORTSMOUTH OH
45662-5760
US

V. Phone/Fax

Practice location:
  • Phone: 740-550-5228
  • Fax:
Mailing address:
  • Phone: 740-981-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.174064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: