Provider Demographics
NPI:1457422685
Name:KUTYNA, PATRICIA ANN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:KUTYNA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 4TH ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4266
Mailing Address - Country:US
Mailing Address - Phone:309-346-2877
Mailing Address - Fax:309-346-7663
Practice Address - Street 1:6 S 4TH ST
Practice Address - Street 2:UNIT 1
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4266
Practice Address - Country:US
Practice Address - Phone:309-346-2877
Practice Address - Fax:309-346-7663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical