MEDICARE: SUZANNE HUBBARD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	12093-C	AR
2	171M00000X	Case Manager/Care Coordinator
3	104100000X	Social Worker

General Provider Information

NPI Number	:	1376144816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE HUBBARD LCSW

Provider Business Mailing Address
First Line	:	5512 W WALSH LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8947
Country	:	US
Telephone Number	:	479-595-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	5512 W WALSH LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8947
Country	:	US
Telephone Number	:	501-595-0333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	04/16/2025

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