Provider Demographics
NPI:1558059766
Name:HUBBARD, ANGIE
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
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 1:5500 RIDGE RD STE 226
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2367
Mailing Address - Country:US
Mailing Address - Phone:440-340-5086
Mailing Address - Fax:440-340-5286
Practice Address - Street 1:3966 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6770
Practice Address - Country:US
Practice Address - Phone:440-340-5086
Practice Address - Fax:440-340-5286
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator