Provider Demographics
NPI:1538609656
Name:HUTKOWSKI, JENNIFER MAE (MSW, LLMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:HUTKOWSKI
Suffix:
Gender:F
Credentials:MSW, LLMSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MAE
Other - Last Name:PERRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LLMSW
Mailing Address - Street 1:P.O. BOX 183
Mailing Address - Street 2:1322 N. RIVER RD.
Mailing Address - City:ST. CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-2803
Mailing Address - Country:US
Mailing Address - Phone:810-329-4798
Mailing Address - Fax:810-329-7303
Practice Address - Street 1:1322 N. RIVER RD.
Practice Address - Street 2:
Practice Address - City:ST. CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-2803
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:810-329-7303
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100703104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker