Healthcare Provider Details

I. General information

NPI: 1164187753
Provider Name (Legal Business Name): RAE ANNA HUFFMAN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 N. MULBERRY STREET
MOUNT PLEASANT TX
75455
US

IV. Provider business mailing address

2001 N JEFFERSON AVE
MOUNT PLEASANT TX
75455-2338
US

V. Phone/Fax

Practice location:
  • Phone: 903-434-8030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: