Provider Demographics
NPI:1942898309
Name:HUDDLESTON, DENISE A
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S 400 E APT 111
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2161
Mailing Address - Country:US
Mailing Address - Phone:385-209-8765
Mailing Address - Fax:
Practice Address - Street 1:134 S 400 E APT 111
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84111-2161
Practice Address - Country:US
Practice Address - Phone:385-209-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner