Healthcare Provider Details

I. General information

NPI: 1780122291
Provider Name (Legal Business Name): VALERIE KLEESPIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WEST BROADWAY STREET SUITE 2
HOBBS NM
88240
US

IV. Provider business mailing address

215 W BROADWAY ST SUITE 2
HOBBS NM
88240-6065
US

V. Phone/Fax

Practice location:
  • Phone: 575-605-7074
  • Fax:
Mailing address:
  • Phone: 575-605-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM09245
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: