Provider Demographics
NPI:1215743984
Name:KUBALEK, HEATHER MARIE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:KUBALEK
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 1:884 PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3538
Mailing Address - Country:US
Mailing Address - Phone:813-602-9911
Mailing Address - Fax:
Practice Address - Street 1:884 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3538
Practice Address - Country:US
Practice Address - Phone:813-602-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.0056161041C0700X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical