Provider Demographics
NPI:1053672873
Name:JUBELT, LEAH ALEXIS
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ALEXIS
Last Name:JUBELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94405A TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-3264
Mailing Address - Country:US
Mailing Address - Phone:315-420-0044
Mailing Address - Fax:
Practice Address - Street 1:94405A TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13603-3264
Practice Address - Country:US
Practice Address - Phone:315-420-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator