Provider Demographics
NPI:1811216484
Name:HUEBNER, JODI LYNN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:HUEBNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N LYNNDALE DR STE 2D
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3048
Mailing Address - Country:US
Mailing Address - Phone:920-475-0246
Mailing Address - Fax:
Practice Address - Street 1:1045 N LYNNDALE DR STE 2D
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3048
Practice Address - Country:US
Practice Address - Phone:920-475-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4185-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health