Provider Demographics
NPI:1346380599
Name:KUBIK, JOANNA (PLPC)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:KUBIK
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 TRAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3515
Mailing Address - Country:US
Mailing Address - Phone:573-204-7896
Mailing Address - Fax:
Practice Address - Street 1:619 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4313
Practice Address - Country:US
Practice Address - Phone:573-334-3486
Practice Address - Fax:573-334-3524
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health