Provider Demographics
NPI:1922664911
Name:HUBER, JACQUELINE ANN (MED, LBS BH 001824)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:HUBER
Suffix:
Gender:F
Credentials:MED, LBS BH 001824
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 W HANNAH ST
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-1927
Mailing Address - Country:US
Mailing Address - Phone:814-553-2496
Mailing Address - Fax:
Practice Address - Street 1:1400 FOX HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1877
Practice Address - Country:US
Practice Address - Phone:814-238-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001824103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst