1922766278 NPI number — MRS. JEZEBEL EOWYN RUBIS MSW, LCSW

Table of content: MRS. JEZEBEL EOWYN RUBIS MSW, LCSW (NPI 1922766278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922766278 NPI number — MRS. JEZEBEL EOWYN RUBIS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIS
Provider First Name:
JEZEBEL
Provider Middle Name:
EOWYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEIDENREICH
Provider Other First Name:
JEZEBEL
Provider Other Middle Name:
EOWYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922766278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 E GARFIELD ST STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARAMIE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82070-5172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-840-0728
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 E GARFIELD ST STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82070-5172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-622-6337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1621 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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