Healthcare Provider Details

I. General information

NPI: 1629570684
Provider Name (Legal Business Name): JESSICA CHARLOTTE HUHN-TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 FALCON CT
LARAMIE WY
82072-1877
US

IV. Provider business mailing address

2271 FALCON CT
LARAMIE WY
82072-1877
US

V. Phone/Fax

Practice location:
  • Phone: 307-761-5790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPPC-1055
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: