Healthcare Provider Details

I. General information

NPI: 1265816904
Provider Name (Legal Business Name): JORDAN HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E SUPERIOR ST
CHICAGO IL
60611-2654
US

IV. Provider business mailing address

4400 DEERHAVEN CT
WESTLAKE VILLAGE CA
91362-5646
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.010598
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: