Healthcare Provider Details

I. General information

NPI: 1407232796
Provider Name (Legal Business Name): JODIE LYNNE HUFF CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRECKENRIDGE ST STE 201
OWENSBORO KY
42303-0876
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-3445
  • Fax: 270-688-3444
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC007
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: