Provider Demographics
NPI:1174866792
Name:STUBBS, JENNIFER J (LPC-IT, NCC, SUD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:STUBBS
Suffix:
Gender:F
Credentials:LPC-IT, NCC, SUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-280-2700
Mailing Address - Fax:
Practice Address - Street 1:1320 MENDOTA ST
Practice Address - Street 2:STE 106
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-280-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health