Provider Demographics
NPI:1669219507
Name:HUTCHINSON, EJA MONE
Entity type:Individual
Prefix:
First Name:EJA
Middle Name:MONE
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 QUARTZ DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8347
Mailing Address - Country:US
Mailing Address - Phone:505-315-9978
Mailing Address - Fax:
Practice Address - Street 1:1341 QUARTZ DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8347
Practice Address - Country:US
Practice Address - Phone:505-315-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician