Healthcare Provider Details

I. General information

NPI: 1740717289
Provider Name (Legal Business Name): OLIVIA PUENTE HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA PUENTE LMSW

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 34
JENISON MI
49429-0034
US

IV. Provider business mailing address

PO BOX 34
JENISON MI
49429-0034
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-8229
  • Fax:
Mailing address:
  • Phone: 616-209-8229
  • Fax: 616-236-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106494
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: