Healthcare Provider Details

I. General information

NPI: 1891826574
Provider Name (Legal Business Name): CRYSTAL DAWN HUFF SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CHRISTIAN DR
RAYVILLE LA
71269-3658
US

IV. Provider business mailing address

161 CHRISTIAN DR
RAYVILLE LA
71269-3658
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-3665
  • Fax: 318-728-3625
Mailing address:
  • Phone: 318-728-3665
  • Fax: 318-728-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5442
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: