=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750009775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER TERESA SCHUBBE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2022
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6770 DIXIE HWY STE 200
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48346-5113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-302-3002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3723 SUMMIT CT
-----------------------------------------------------
City | WIXOM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48393-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-302-3002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------