Basic Information
| Provider Information | |||||||||
| NPI: | 1710112834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBER | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | SAULE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, LICSW, C-SSWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33919- 9TH AVE S | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062283537 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 33919 9TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062283537 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2009 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60035034 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041S0200X | 430139F | WA | N | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.