Healthcare Provider Details

I. General information

NPI: 1699549691
Provider Name (Legal Business Name): ADAM CLIFFORD HUOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 NORWAY PINES PL
HERMANTOWN MN
55811-1253
US

IV. Provider business mailing address

4560 NORWAY PINES PL
HERMANTOWN MN
55811-1253
US

V. Phone/Fax

Practice location:
  • Phone: 218-729-6480
  • Fax:
Mailing address:
  • Phone: 218-729-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29574
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: