Provider Demographics
NPI:1649429614
Name:HUTSELL, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:HUTSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S CENTRAL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1511
Mailing Address - Country:US
Mailing Address - Phone:541-899-9194
Mailing Address - Fax:541-899-1519
Practice Address - Street 1:675 N 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9659
Practice Address - Country:US
Practice Address - Phone:541-899-9194
Practice Address - Fax:541-899-1519
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-T-10126936237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212936Medicaid