Provider Demographics
NPI:1376876813
Name:HUFF, JESSICA A (LMP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:HUFF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MELLEN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1173
Mailing Address - Country:US
Mailing Address - Phone:360-330-1800
Mailing Address - Fax:360-330-5866
Practice Address - Street 1:1101 MELLEN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1173
Practice Address - Country:US
Practice Address - Phone:360-330-1800
Practice Address - Fax:360-330-5866
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60092698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist