Provider Demographics
NPI:1699369363
Name:UTTECHT, TOMASINA MARIE
Entity type:Individual
Prefix:
First Name:TOMASINA
Middle Name:MARIE
Last Name:UTTECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 DEERWOODS CT
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:MN
Mailing Address - Zip Code:55360-2119
Mailing Address - Country:US
Mailing Address - Phone:952-235-8929
Mailing Address - Fax:
Practice Address - Street 1:355 2ND ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2059
Practice Address - Country:US
Practice Address - Phone:952-474-0227
Practice Address - Fax:952-474-0249
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health