Provider Demographics
NPI:1538565999
Name:HUTSON, JENNIFER M (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HUTSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17586 2550 RD
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413
Mailing Address - Country:US
Mailing Address - Phone:970-361-8014
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD LN UNIT 30217
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2256
Practice Address - Country:US
Practice Address - Phone:970-361-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.001749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist