Healthcare Provider Details

I. General information

NPI: 1831586304
Provider Name (Legal Business Name): KATHERINE QUICK SSEJJEMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W BROADWAY ST
HOBBS NM
88240-5529
US

IV. Provider business mailing address

PO BOX 907
HOBBS NM
88241-0907
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-3168
  • Fax:
Mailing address:
  • Phone: 575-393-3168
  • Fax: 575-397-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12053
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: