Provider Demographics
NPI:1508995317
Name:HUTCHERSON, ROSWITHA H (AUD)
Entity Type:Individual
Prefix:DR
First Name:ROSWITHA
Middle Name:H
Last Name:HUTCHERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 COYLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6332
Mailing Address - Country:US
Mailing Address - Phone:916-961-2154
Mailing Address - Fax:916-961-7042
Practice Address - Street 1:6633 COYLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6332
Practice Address - Country:US
Practice Address - Phone:916-961-2154
Practice Address - Fax:916-961-7042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1131231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0019360Medicaid
CAAU 1131Medicaid