Provider Demographics
NPI:1306426457
Name:HUBERTY, SHAUNA SUE (LISW)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:SUE
Last Name:HUBERTY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 KILRUSH RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7716
Mailing Address - Country:US
Mailing Address - Phone:507-848-5140
Mailing Address - Fax:
Practice Address - Street 1:309 COURT AVE STE 200
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2230
Practice Address - Country:US
Practice Address - Phone:563-281-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0920851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty