Provider Demographics
NPI:1376739300
Name:HUBIN, KALLI JO (BA)
Entity Type:Individual
Prefix:MS
First Name:KALLI
Middle Name:JO
Last Name:HUBIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:KALLI
Other - Middle Name:JO
Other - Last Name:HUEHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1821 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE N385
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:651-644-8515
Mailing Address - Fax:651-644-3451
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE N385
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:651-644-8515
Practice Address - Fax:651-644-3451
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator