Provider Demographics
NPI:1487420238
Name:HUDDLESTON, JESSICA A (AUD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 MONTEREY PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2922
Mailing Address - Country:US
Mailing Address - Phone:405-831-7076
Mailing Address - Fax:
Practice Address - Street 1:424 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5942
Practice Address - Country:US
Practice Address - Phone:405-650-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5818231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist