Healthcare Provider Details

I. General information

NPI: 1265345698
Provider Name (Legal Business Name): BRANDY R HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 E JEFFERSON BLVD
SOUTH BEND IN
46617-2903
US

IV. Provider business mailing address

18280 AMBERLY LN
SOUTH BEND IN
46637-4404
US

V. Phone/Fax

Practice location:
  • Phone: 574-213-2902
  • Fax:
Mailing address:
  • Phone: 574-386-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012831A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: