Healthcare Provider Details

I. General information

NPI: 1144533423
Provider Name (Legal Business Name): LOREN HUFFINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 BEVILLE RD SUITE G
SOUTH DAYTONA FL
32119-1712
US

IV. Provider business mailing address

206 LAKESHORE DR
PALESTINE TX
75801-5236
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-4395
  • Fax: 866-426-2811
Mailing address:
  • Phone: 903-714-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number102727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: