Provider Demographics
NPI:1093795254
Name:HUTCHISON, RICHARD ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:HUTCHISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61266-0086
Mailing Address - Country:US
Mailing Address - Phone:309-797-6979
Mailing Address - Fax:309-797-6986
Practice Address - Street 1:3919 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7217
Practice Address - Country:US
Practice Address - Phone:309-797-6979
Practice Address - Fax:309-797-6986
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003249103TC0700X
IA00511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL967340Medicare ID - Type Unspecified