Provider Demographics
NPI:1740671627
Name:HUBBELL, JENNIFER JO
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JO
Last Name:HUBBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11590 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CEMENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49233-9525
Mailing Address - Country:US
Mailing Address - Phone:517-320-5164
Mailing Address - Fax:
Practice Address - Street 1:97 S BROAD ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-2082
Practice Address - Country:US
Practice Address - Phone:517-437-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004941225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist