Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1093379448 |
---|---|
Provider Name | Jill J Hutzel |
First Address | Fredericksburg, VA 22405-2337 |
Second Address | Stafford, VA 22554-7246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2019 |
Last Update Date | 30/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1818 | (05) | VA |