Healthcare Provider Details

I. General information

NPI: 1134710056
Provider Name (Legal Business Name): JOSHUA HUFFINE CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N HANCOCK ST
OTTUMWA IA
52501-4648
US

IV. Provider business mailing address

102 N HANCOCK ST
OTTUMWA IA
52501-4648
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-2800
  • Fax: 641-682-2826
Mailing address:
  • Phone: 641-682-2800
  • Fax: 641-682-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT20049
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: