Provider Demographics
NPI:1174009906
Name:KAUBLE, ANDREA M
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:KAUBLE
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:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:BETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44815-0284
Mailing Address - Country:US
Mailing Address - Phone:567-207-7356
Mailing Address - Fax:
Practice Address - Street 1:200 S ARCH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2961
Practice Address - Country:US
Practice Address - Phone:567-207-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22037111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical