Provider Demographics
NPI:1346592334
Name:HUFFSTETLER, DONNA H
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:H
Last Name:HUFFSTETLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:H
Other - Last Name:HUFFSTETLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:3950 PALM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1579
Mailing Address - Country:US
Mailing Address - Phone:904-392-1949
Mailing Address - Fax:
Practice Address - Street 1:1797 OLD MOULTRIE RD
Practice Address - Street 2:109
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4171
Practice Address - Country:US
Practice Address - Phone:904-824-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist