Healthcare Provider Details

I. General information

NPI: 1124387592
Provider Name (Legal Business Name): ANNE HOVLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4185 SW RESEARCH WAY
CORVALLIS OR
97333-1783
US

IV. Provider business mailing address

4185 SW RESEARCH WAY
CORVALLIS OR
97333-1783
US

V. Phone/Fax

Practice location:
  • Phone: 541-257-5500
  • Fax:
Mailing address:
  • Phone: 541-257-5500
  • Fax: 541-286-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3458
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: