Healthcare Provider Details

I. General information

NPI: 1144974189
Provider Name (Legal Business Name): DESIREE HOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32734 NE 195TH ST
DUVALL WA
98019-9734
US

IV. Provider business mailing address

32734 NE 195TH ST
DUVALL WA
98019-9734
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-2042
  • Fax:
Mailing address:
  • Phone: 907-854-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60559108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: