Healthcare Provider Details

I. General information

NPI: 1538877246
Provider Name (Legal Business Name): BRENDA HUFFSTUTLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 NE 134TH ST STE 180-B
VANCOUVER WA
98685-2799
US

IV. Provider business mailing address

8602 NE 31ST CT
VANCOUVER WA
98665-1134
US

V. Phone/Fax

Practice location:
  • Phone: 360-836-9715
  • Fax:
Mailing address:
  • Phone: 360-836-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60438671
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: