Healthcare Provider Details

I. General information

NPI: 1770776551
Provider Name (Legal Business Name): KATIE A HOBBS LCSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE A KELLY

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 5TH ST STE 300
BROOKINGS OR
97415-9199
US

IV. Provider business mailing address

PO BOX 1121
ROSEBURG OR
97470-0254
US

V. Phone/Fax

Practice location:
  • Phone: 877-408-8941
  • Fax:
Mailing address:
  • Phone: 541-672-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL12352
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: