MEDICARE: MS. JACQUELINE R HUBKA MA, CEAP, LPC

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	101YP2500X	Professional Counselor	C1253	OR

General Provider Information

NPI Number	:	1174612261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE R HUBKA MA, CEAP, LPC

Provider Business Mailing Address
First Line	:	7033 SW MACADAM AVE STE 104
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-2371
Country	:	US
Telephone Number	:	503-310-7435
Fax Number	:

Provider Business Practice Location Address
First Line	:	7033 SW MACADAM AVE STE 104
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-2371
Country	:	US
Telephone Number	:	503-310-7435
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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