Provider Demographics
NPI:1730302746
Name:HUDDLESTON, AMY M (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-8603
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-379-8190
Practice Address - Fax:330-379-8191
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH6244103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2754747Medicaid
OH2754747Medicaid