Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | SC60779475 | WA |
N | 104100000X | Social Worker | SC60779475 | WA |
NPI | 1003368044 |
---|---|
Provider Name | Dusti Marie Huddleston |
First Address | Spokane, WA 99202-1510 |
Second Address | Spokane, WA 99208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 19/12/2018 |