Provider Demographics
NPI:1366795924
Name:HUBBARD, JEANNIE M
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:M
Last Name:HUBBARD
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 1:655 GOODPASTURE ISLAND RD APT 147
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1532
Mailing Address - Country:US
Mailing Address - Phone:541-968-9286
Mailing Address - Fax:
Practice Address - Street 1:655 GOODPASTURE ISLAND RD APT 147
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1532
Practice Address - Country:US
Practice Address - Phone:541-968-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0088171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator