Provider Demographics
NPI:1538877246
Name:HUFFSTUTLER, BRENDA (LICSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HUFFSTUTLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 NE 31ST CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-1134
Mailing Address - Country:US
Mailing Address - Phone:360-836-9715
Mailing Address - Fax:
Practice Address - Street 1:1404 NE 134TH ST STE 180-B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2799
Practice Address - Country:US
Practice Address - Phone:360-836-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604386711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical