Provider Demographics
NPI:1437626660
Name:HUCKABY, CASSIE D'LYNN
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:D'LYNN
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15139 WOODS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-7307
Mailing Address - Country:US
Mailing Address - Phone:806-543-1603
Mailing Address - Fax:
Practice Address - Street 1:15139 WOODS VALLEY RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-7307
Practice Address - Country:US
Practice Address - Phone:806-543-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath