Provider Demographics
NPI:1033253208
Name:HUTCHINSON, EBONY CHERI (PLCSW)
Entity Type:Individual
Prefix:MS
First Name:EBONY
Middle Name:CHERI
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7218 BURRWOOD DR
Mailing Address - Street 2:APT. E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-1651
Mailing Address - Country:US
Mailing Address - Phone:314-518-2882
Mailing Address - Fax:
Practice Address - Street 1:7401 FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4835
Practice Address - Country:US
Practice Address - Phone:314-261-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060318671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496950403Medicaid