Provider Demographics
NPI:1053711754
Name:STUBER, JAN (SLP)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:STUBER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LEE
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3072 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1539
Mailing Address - Country:US
Mailing Address - Phone:614-551-7256
Mailing Address - Fax:
Practice Address - Street 1:3072 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-1539
Practice Address - Country:US
Practice Address - Phone:614-551-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 8678235Z00000X
OH1205124235Z00000X
OH1204080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist