Healthcare Provider Details

I. General information

NPI: 1306285069
Provider Name (Legal Business Name): CONNIE HOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W SAGINAW ST
LANSING MI
48915-1963
US

IV. Provider business mailing address

812 E JOLLY RD SUITE 210
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-2949
  • Fax:
Mailing address:
  • Phone: 517-346-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4703065221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: