Provider Demographics
NPI:1922154574
Name:HUOTARI, TAMMY JAYNE (LMSW, CAAC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:JAYNE
Last Name:HUOTARI
Suffix:
Gender:F
Credentials:LMSW, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24260 W. GROSVENORS DR.
Mailing Address - Street 2:
Mailing Address - City:BRIMLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49715
Mailing Address - Country:US
Mailing Address - Phone:906-437-5546
Mailing Address - Fax:
Practice Address - Street 1:400 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1979
Practice Address - Country:US
Practice Address - Phone:906-635-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010829641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical