MEDICARE: JADE HUBBARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003383423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE HUBBARD

Provider Business Mailing Address
First Line	:	678 NEWMAN LN
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-3300
Country	:	US
Telephone Number	:	248-254-2616
Fax Number	:

Provider Business Practice Location Address
First Line	:	6275 SCHAEFER RD. SUITE 105
Second Line	:	SUITE 105
City	:	DEARBORN
State	:	MI
Zip	:	48126-4812
Country	:	US
Telephone Number	:	313-652-6701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/24/2018

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Directions to “ JADE HUBBARD ” Practice Location

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