Healthcare Provider Details

I. General information

NPI: 1427681188
Provider Name (Legal Business Name): JACOB HUFF LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRUGH AVE
BUTLER PA
16001-6428
US

IV. Provider business mailing address

100 BRUGH AVE
BUTLER PA
16001-6428
US

V. Phone/Fax

Practice location:
  • Phone: 724-284-9440
  • Fax: 724-284-9441
Mailing address:
  • Phone: 724-284-9440
  • Fax: 724-284-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: