Provider Demographics
NPI:1932318581
Name:HOUCK, ANN WHITEHEAD (MT-BC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:WHITEHEAD
Last Name:HOUCK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22935 FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-7885
Mailing Address - Country:US
Mailing Address - Phone:507-685-4662
Mailing Address - Fax:
Practice Address - Street 1:22935 FARWELL AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-7885
Practice Address - Country:US
Practice Address - Phone:507-685-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist