Provider Demographics
NPI:1427633924
Name:HUCKFELDT, JORDAN CHRISTINE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHRISTINE
Last Name:HUCKFELDT
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 1:6367 ELKHART DR
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:MI
Mailing Address - Zip Code:49730-9342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6367 ELKHART DR
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:MI
Practice Address - Zip Code:49730-9342
Practice Address - Country:US
Practice Address - Phone:307-401-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician