Active NPI
Angela Bub, LCSW LICSW CCTP
- Clinical Social Worker
- Duluth, MN
National Provider Identifier
1013308329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 29234
- Practice address
- 4720 Burning Tree Rd
Duluth, MN 55811-2634 - Phone
- (218) 623-1812
- NPI assigned
- Feb 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 70479 | CA | |
| Clinical Social Worker | 1041C0700X | 9995123 | WI | |
| Clinical Social Worker | 1041C0700X | 29234 | MN | Primary |
Addresses
Primary practice location
4720 Burning Tree Rd
Duluth, MN 55811-2634
Mailing address
4720 Burning Tree Rd
Duluth, MN 55811-2634
Phone (218) 623-1812
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9995123 | WI | MD | Clinical Social Worker |
| 29234 | MN | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659657600000",
"number": "1013308329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4720 BURNING TREE RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558112634",
"telephone_number": "218-623-1812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4720 BURNING TREE RD",
"city": "DULUTH",
"state": "MN",
"postal_code": "558112634",
"telephone_number": "218-623-1812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUB",
"first_name": "ANGELA",
"credential": "LCSW LICSW CCTP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-09",
"last_updated": "2022-08-05",
"certification_date": "2022-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "70479",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "9995123",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "29234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.