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General NPI Number Information
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NPI Number | 1609322791
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Entity Type | Organization
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Legal Business Name | DIANE BUBECK LTD
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 3528 BECKET LN
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City | NAPERVILLE
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State | IL
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Zip | 60564-4141
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Country | US
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Telephone | 630-664-9702
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Fax | 630-369-5651
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Provider Business Mailing Address
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Address Line | 3528 BECKET LN
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City | NAPERVILLE
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State | IL
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Zip | 60564-4141
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Country | US
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Telephone | 630-369-5645
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Fax | 630-369-5651
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. DIANE THERESE BUBECK
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Credential | RD, LMFT
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Telephone | 630-369-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000604
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.001456
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License Number State | IL
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