Provider Demographics
NPI:1659621126
Name:KUBROCK, EMMA L (MS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:L
Last Name:KUBROCK
Suffix:
Gender:F
Credentials:MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1771
Mailing Address - Country:US
Mailing Address - Phone:509-529-5207
Mailing Address - Fax:509-525-3741
Practice Address - Street 1:1775 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1771
Practice Address - Country:US
Practice Address - Phone:509-529-5207
Practice Address - Fax:509-525-3741
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA457453R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist