Provider Demographics
NPI:1780216309
Name:HUTTNER, ROBERTA WENDY (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:WENDY
Last Name:HUTTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:HUTTNER
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:907 N EL PASO ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2929
Mailing Address - Country:US
Mailing Address - Phone:719-510-8385
Mailing Address - Fax:
Practice Address - Street 1:907 N EL PASO ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2929
Practice Address - Country:US
Practice Address - Phone:719-510-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW009925391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical