Healthcare Provider Details

I. General information

NPI: 1992073001
Provider Name (Legal Business Name): MR. BRIAN A HUTCHINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8538 IVY HILL DR
POLAND OH
44514-5212
US

IV. Provider business mailing address

8538 IVY HILL DR
POLAND OH
44514-5212
US

V. Phone/Fax

Practice location:
  • Phone: 724-584-2429
  • Fax:
Mailing address:
  • Phone: 724-584-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP9718
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: