Provider Demographics
NPI:1861927162
Name:HUDDLESTON, AMY (SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6237
Mailing Address - Country:US
Mailing Address - Phone:713-523-3633
Mailing Address - Fax:713-523-8399
Practice Address - Street 1:3636 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-1704
Practice Address - Country:US
Practice Address - Phone:713-523-3529
Practice Address - Fax:713-523-8399
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist