Provider Demographics
NPI:1467506105
Name:HUFFMAN, DAWN NICHOLSON (SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:NICHOLSON
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CAR FARM RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7105
Mailing Address - Country:US
Mailing Address - Phone:828-461-4596
Mailing Address - Fax:704-735-1226
Practice Address - Street 1:243 CAR FARM RD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7105
Practice Address - Country:US
Practice Address - Phone:828-461-4596
Practice Address - Fax:704-735-1226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412572Medicaid