Provider Demographics
NPI:1922766278
Name:RUBIS, JEZEBEL EOWYN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEZEBEL
Middle Name:EOWYN
Last Name:RUBIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JEZEBEL
Other - Middle Name:EOWYN
Other - Last Name:HEIDENREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3704
Mailing Address - Country:US
Mailing Address - Phone:307-840-0728
Mailing Address - Fax:
Practice Address - Street 1:502 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3704
Practice Address - Country:US
Practice Address - Phone:307-755-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical