Healthcare Provider Details

I. General information

NPI: 1952639031
Provider Name (Legal Business Name): DAWN HUFFMAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3243 TATES WAY
INDIANAPOLIS IN
46268-8620
US

IV. Provider business mailing address

3243 TATES WAY
INDIANAPOLIS IN
46268-8620
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-2861
  • Fax:
Mailing address:
  • Phone: 317-271-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004637A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: