Provider Demographics
NPI:1770737025
Name:HUTTON, HAZEL ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:ANN
Last Name:HUTTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:ANN
Other - Last Name:CORKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:118 BROADWAY
Mailing Address - Street 2:SUITE 517
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-476-0497
Mailing Address - Fax:701-298-7811
Practice Address - Street 1:118 BROADWAY
Practice Address - Street 2:SUITE 517
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-476-0497
Practice Address - Fax:701-298-7811
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)