Healthcare Provider Details

I. General information

NPI: 1063573707
Provider Name (Legal Business Name): PAMELA SUE HUTCHINSON MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S 2ND ST
MOUNT VERNON WA
98273-4209
US

IV. Provider business mailing address

1616 SPRUCE CT
MOUNT VERNON WA
98273-3000
US

V. Phone/Fax

Practice location:
  • Phone: 360-419-3552
  • Fax: 360-419-3535
Mailing address:
  • Phone: 360-848-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00004265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: