Healthcare Provider Details

I. General information

NPI: 1487719829
Provider Name (Legal Business Name): MRS. EVELYN C DOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 CORPORATE SQUARE DR
SLIDELL LA
70458-3152
US

IV. Provider business mailing address

857 BROWNSWITCH RD 295
SLIDELL LA
70458-5335
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-9241
  • Fax: 985-643-9479
Mailing address:
  • Phone: 985-643-9241
  • Fax: 985-643-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12435
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: