Healthcare Provider Details

I. General information

NPI: 1801462437
Provider Name (Legal Business Name): JODI ELIZABETH HUFFMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 BARBER DR
CARBONDALE CO
81623-1886
US

IV. Provider business mailing address

1379 BARBER DR
CARBONDALE CO
81623-1886
US

V. Phone/Fax

Practice location:
  • Phone: 410-790-1076
  • Fax:
Mailing address:
  • Phone: 410-790-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62519
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: