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General NPI Number Information
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NPI Number | 1730360967
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Entity Type | Organization
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Legal Business Name | SUE HUBER & ASSOCIATES, S.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 1039 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-1842
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Country | US
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Telephone | 920-965-7754
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Fax |
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Provider Business Mailing Address
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Address Line | 1039 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-1842
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Country | US
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Telephone | 920-965-7754
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Fax |
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Authorized Official
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Title or Position | THERAPIST/CLINIC DIRECTOR
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Name | SUE HUBER
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Credential | MSW
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Telephone | 920-965-7754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3744-123
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License Number State | WI
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