Individual
JESSICA LAINE HUETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD, LAT, ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(555) 555-5555
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(555) 555-5555
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002472A
IN
Other
Enumeration date
04/23/2007
Last updated
06/12/2024
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