Provider Demographics
NPI:1710112834
Name:HUBER, LYDIA SAULE (MSW, LICSW, C-SSWS)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:SAULE
Last Name:HUBER
Suffix:
Gender:F
Credentials:MSW, LICSW, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33919- 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:206-228-3537
Mailing Address - Fax:
Practice Address - Street 1:33919 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6742
Practice Address - Country:US
Practice Address - Phone:206-228-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600350341041C0700X
WA430139F1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool