Provider Demographics
NPI:1689977795
Name:HUBER, STEVAN K (LICSW)
Entity Type:Individual
Prefix:
First Name:STEVAN
Middle Name:K
Last Name:HUBER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 CAMPUS DR SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4825
Mailing Address - Country:US
Mailing Address - Phone:507-328-6267
Mailing Address - Fax:507-328-6263
Practice Address - Street 1:2117 CAMPUS DR SE STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4825
Practice Address - Country:US
Practice Address - Phone:507-328-6267
Practice Address - Fax:507-328-6263
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical