Healthcare Provider Details

I. General information

NPI: 1841307204
Provider Name (Legal Business Name): ANN MARIE WRUBEL LMSW, CAC-1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 WATER ST
PORT HURON MI
48060-2543
US

IV. Provider business mailing address

2186 WATER ST
PORT HURON MI
48060-2543
US

V. Phone/Fax

Practice location:
  • Phone: 810-216-9588
  • Fax:
Mailing address:
  • Phone: 810-216-9588
  • Fax: 810-966-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801046022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: