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General NPI Number Information
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NPI Number | 1801533989
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Entity Type | Individual
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Provider Name | ANNETTE E HUDDLESTON MSW, CADC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 425 E STATE ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2125
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Country | US
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Telephone | 217-408-1195
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Fax | 217-408-1231
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Provider Business Mailing Address
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Address Line | 425 E STATE ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2125
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Country | US
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Telephone | 217-408-1195
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Fax | 217-408-1231
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13872
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 13872
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License Number State | IL
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