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NPI Code Detail

MEDICARE: ANGELA BUB LCSW LICSW CCTP

MEDICARE: ANGELA BUB LCSW LICSW CCTP
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
1104100000XSocial Worker70479CA
21041C0700XClinical Social Worker9995123WI
31041C0700XClinical Social Worker29234MN

General Provider Information

NPI Number : 1013308329
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA BUB LCSW LICSW CCTP
Provider Business Mailing Address
First Line : 4720 BURNING TREE RD
Second Line :
City : DULUTH
State : MN
Zip : 55811-2634
Country : US
Telephone Number : 218-623-1812
Fax Number :
Provider Business Practice Location Address
First Line : 4720 BURNING TREE RD
Second Line :
City : DULUTH
State : MN
Zip : 55811-2634
Country : US
Telephone Number : 218-623-1812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2015
Last Update Date : 08/05/2022

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Directions to “ ANGELA BUB LCSW LICSW CCTP” Practice Location

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