Provider Demographics
NPI:1518339720
Name:HUBBARD, KATHERINE JEAN
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JEAN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 RAWSON ST
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7772
Mailing Address - Country:US
Mailing Address - Phone:801-518-0393
Mailing Address - Fax:
Practice Address - Street 1:482 CONSTITUTION WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3565
Practice Address - Country:US
Practice Address - Phone:208-932-4493
Practice Address - Fax:208-932-4582
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional