Provider Demographics
NPI:1245926732
Name:STUBER, MELISSA ANNE (LADC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:STUBER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:NEW AUBURN
Mailing Address - State:MN
Mailing Address - Zip Code:55366-0285
Mailing Address - Country:US
Mailing Address - Phone:417-355-7871
Mailing Address - Fax:
Practice Address - Street 1:114 MAIN ST N STE 2108
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1819
Practice Address - Country:US
Practice Address - Phone:320-573-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306563101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)