Healthcare Provider Details

I. General information

NPI: 1073855672
Provider Name (Legal Business Name): COURTNEY LAYNE HUDDLESTON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LAYNE HAUGSTAD

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 W SUPERIOR ST STE 300
DULUTH MN
55802-1844
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-4397
  • Fax: 218-722-4333
Mailing address:
  • Phone: 516-289-5666
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: