Provider Demographics
NPI:1013095397
Name:HUFFMAN, MYRA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:JEAN
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 1:8305 PINE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4400
Mailing Address - Country:US
Mailing Address - Phone:502-937-2587
Mailing Address - Fax:502-937-8482
Practice Address - Street 1:8305 PINE GROVE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4400
Practice Address - Country:US
Practice Address - Phone:502-937-2587
Practice Address - Fax:502-937-8482
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY138101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty