Provider Demographics
NPI:1730529504
Name:HUBBELL, SUSAN (MSW, APSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HUBBELL
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N14W23755 STONE RIDGE DR
Mailing Address - Street 2:#265
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1147
Mailing Address - Country:US
Mailing Address - Phone:262-547-6557
Mailing Address - Fax:262-547-3644
Practice Address - Street 1:N14W23755 STONE RIDGE DR
Practice Address - Street 2:#265
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1147
Practice Address - Country:US
Practice Address - Phone:262-547-6557
Practice Address - Fax:262-547-3644
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI205-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker