Healthcare Provider Details

I. General information

NPI: 1295275907
Provider Name (Legal Business Name): ALLISON MARY HUTCHISON MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON MARY HODOROWICZ MS, CF-SLP

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 88TH AVE
KENOSHA WI
53144-7468
US

IV. Provider business mailing address

9305 JACKSON PARK BLVD
WAUWATOSA WI
53226-2615
US

V. Phone/Fax

Practice location:
  • Phone: 262-653-0850
  • Fax:
Mailing address:
  • Phone: 815-382-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4299-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: