Healthcare Provider Details

I. General information

NPI: 1225125727
Provider Name (Legal Business Name): AUDRA HUFFSTETLER M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OVERLOOK TRL
WILLIAMSON GA
30292-3151
US

IV. Provider business mailing address

31 OVERLOOK TRL
WILLIAMSON GA
30292-3151
US

V. Phone/Fax

Practice location:
  • Phone: 770-313-6426
  • Fax: 770-412-8978
Mailing address:
  • Phone: 770-313-6426
  • Fax: 770-412-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP005368
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: