Healthcare Provider Details

I. General information

NPI: 1508819699
Provider Name (Legal Business Name): JENNIFER L. HUFFMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 S HAGADORN RD SUITE 2G
EAST LANSING MI
48823-5385
US

IV. Provider business mailing address

4572 S HAGADORN RD SUITE 2G
EAST LANSING MI
48823-5385
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-9554
  • Fax: 517-337-9545
Mailing address:
  • Phone: 517-337-9554
  • Fax: 517-337-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301011260
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: