Basic Information
| Provider Information | |||||||||
| NPI: | 1437356292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUTCHINSON | ||||||||
| FirstName: | VICKIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYCHOLOGIST PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SVOLOS | ||||||||
| OtherFirstName: | VICKIE | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15 GLENWOOD DR | ||||||||
| Address2: | |||||||||
| City: | OIL CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146770792 | ||||||||
| FaxNumber: | 8146770792 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 STAMBAUGH AVE | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS007071L | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 0019493640003 | 05 | PA | MEDICAID |