Provider Demographics
NPI:1497202733
Name:CHUBB, KATHLEEN RUTH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RUTH
Last Name:CHUBB
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-2149
Mailing Address - Country:US
Mailing Address - Phone:734-757-5602
Mailing Address - Fax:
Practice Address - Street 1:7160 TAFT ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2149
Practice Address - Country:US
Practice Address - Phone:734-757-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
MI11936890103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1497202733Medicaid