MEDICARE: MRS. JEZEBEL EOWYN RUBIS MSW, 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	1041C0700X	Clinical Social Worker	1621	WY

General Provider Information

NPI Number	:	1922766278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEZEBEL EOWYN RUBIS MSW, LCSW

Provider Business Mailing Address
First Line	:	710 E GARFIELD ST STE 209
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5172
Country	:	US
Telephone Number	:	307-840-0728
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 E GARFIELD ST STE 209
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5172
Country	:	US
Telephone Number	:	307-622-6337
Fax Number	:

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

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	12/13/2025

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