Provider Demographics
NPI:1336239581
Name:HUFFAR, MARLENE R (CADC III)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:R
Last Name:HUFFAR
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121
Mailing Address - Country:US
Mailing Address - Phone:262-741-3200
Mailing Address - Fax:262-741-3216
Practice Address - Street 1:W4051 COUNTY RD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121
Practice Address - Country:US
Practice Address - Phone:262-741-3200
Practice Address - Fax:262-741-3217
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI961101YA0400X
WI1204-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10151OtherDEAN HEALTH IND PROV #
WI42124600Medicaid