Healthcare Provider Details

I. General information

NPI: 1093379448
Provider Name (Legal Business Name): JILL J HUTZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STAFFORD AVE
STAFFORD VA
22554-7246
US

IV. Provider business mailing address

303 KING ST
FREDERICKSBURG VA
22405-2337
US

V. Phone/Fax

Practice location:
  • Phone: 540-658-6300
  • Fax:
Mailing address:
  • Phone: 540-287-1114
  • 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: