Healthcare Provider Details

I. General information

NPI: 1932318581
Provider Name (Legal Business Name): ANN WHITEHEAD HOUCK MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22935 FARWELL AVE
FARIBAULT MN
55021-7885
US

IV. Provider business mailing address

22935 FARWELL AVE
FARIBAULT MN
55021-7885
US

V. Phone/Fax

Practice location:
  • Phone: 507-685-4662
  • Fax:
Mailing address:
  • Phone: 507-685-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: