Provider Demographics
NPI:1063477305
Name:CLAYTON-HUTFLES, JENNIFER (RPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CLAYTON-HUTFLES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 115TH ST
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:KS
Mailing Address - Zip Code:66439-9573
Mailing Address - Country:US
Mailing Address - Phone:785-486-2967
Mailing Address - Fax:
Practice Address - Street 1:120 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521-9574
Practice Address - Country:US
Practice Address - Phone:785-889-4921
Practice Address - Fax:785-889-4117
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140911OtherBLUE SHIELD