Provider Demographics
NPI:1801448618
Name:HUEY, JENNA SAMANTHA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:SAMANTHA
Last Name:HUEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:SAMANTHA
Other - Last Name:LONDYNSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SWLC
Mailing Address - Street 1:512 E CURTISS ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4821
Mailing Address - Country:US
Mailing Address - Phone:862-200-4312
Mailing Address - Fax:
Practice Address - Street 1:2725 JACKRABBIT LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5716
Practice Address - Country:US
Practice Address - Phone:862-200-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT386481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical