Provider Demographics
NPI:1225125727
Name:HUFFSTETLER, AUDRA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:HUFFSTETLER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OVERLOOK TRL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30292-3151
Mailing Address - Country:US
Mailing Address - Phone:770-313-6426
Mailing Address - Fax:770-412-8978
Practice Address - Street 1:31 OVERLOOK TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:GA
Practice Address - Zip Code:30292-3151
Practice Address - Country:US
Practice Address - Phone:770-313-6426
Practice Address - Fax:770-412-8978
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist