=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215456538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ROSE KUBE PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1819 N SAINT LOUIS AVE APT 2RN
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60647-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-231-7985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1819 N SAINT LOUIS AVE APT 2RN
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60647-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-741-0607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 4899
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------