Provider Demographics
NPI:1144278086
Name:HUTZELL, ROBERT RAYMOND (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAYMOND
Last Name:HUTZELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-0112
Mailing Address - Country:US
Mailing Address - Phone:641-842-2415
Mailing Address - Fax:
Practice Address - Street 1:1515 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3354
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:641-828-5307
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical