MEDICARE: JEAN R HUTCHINSON LCSW

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	1041C0700X	Clinical Social Worker	149009383	IL

General Provider Information

NPI Number	:	1760730915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN R HUTCHINSON LCSW

Provider Business Mailing Address
First Line	:	1625 SHERIDAN RD
Second Line	:	507
City	:	WILMETTE
State	:	IL
Zip	:	60091-1824
Country	:	US
Telephone Number	:	847-409-2866
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 N MICHIGAN AVE
Second Line	:	31ST FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60611-1803
Country	:	US
Telephone Number	:	312-544-0551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	12/18/2012

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