Provider Demographics
NPI:1508819699
Name:HUFFMAN, JENNIFER L (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 S HAGADORN RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5385
Mailing Address - Country:US
Mailing Address - Phone:517-337-9554
Mailing Address - Fax:517-337-9545
Practice Address - Street 1:4572 S HAGADORN RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-337-9554
Practice Address - Fax:517-337-9545
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011260103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C31232OtherBLUE SHIELD OF MICHIGAN
MI680C31232OtherBLUE SHIELD OF MICHIGAN