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General NPI Number Information
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NPI Number | 1467047068
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Entity Type | Individual
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Provider Name | KATHLEEN REID LUBERA MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 22221 GREATER MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2351
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Country | US
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Telephone | 313-815-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 1059 ROSLYN RD
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-1349
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Country | US
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Telephone | 313-815-0083
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101000933
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License Number State | MI
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