Healthcare Provider Details

I. General information

NPI: 1144432733
Provider Name (Legal Business Name): MRS. MARIE NMI HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 CHICAGO RD
WATERMAN IL
60556-7007
US

IV. Provider business mailing address

8222 CHICAGO RD
WATERMAN IL
60556-7007
US

V. Phone/Fax

Practice location:
  • Phone: 815-264-3356
  • Fax: 805-264-3356
Mailing address:
  • Phone: 815-264-3356
  • Fax: 805-264-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: