MEDICARE: HUTNER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	20041381A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720145774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUTNER, INC.

Provider Business Mailing Address
First Line	:	3240 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2883
Country	:	US
Telephone Number	:	260-341-5848
Fax Number	:	260-755-5927

Provider Business Practice Location Address
First Line	:	3240 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2883
Country	:	US
Telephone Number	:	260-341-5848
Fax Number	:	260-755-5927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN DOUGLAS HUTNER
Credential	:	PSY.D., HSPP
Telephone Number	:	260-341-5848

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/31/2014

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