Provider Demographics
NPI:1285174763
Name:HUTTON, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2529
Mailing Address - Country:US
Mailing Address - Phone:563-212-5726
Mailing Address - Fax:
Practice Address - Street 1:1122 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-1461
Practice Address - Country:US
Practice Address - Phone:815-244-1376
Practice Address - Fax:815-244-3074
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health