Provider Demographics
NPI:1306229539
Name:HUBER, JENNIFER RACHAEL (LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHAEL
Last Name:HUBER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16920 SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9616
Mailing Address - Country:US
Mailing Address - Phone:937-642-0048
Mailing Address - Fax:937-642-1316
Practice Address - Street 1:16920 SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9616
Practice Address - Country:US
Practice Address - Phone:937-642-0048
Practice Address - Fax:937-642-1316
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15000891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical