Healthcare Provider Details

I. General information

NPI: 1104563808
Provider Name (Legal Business Name): BRIANA JEAN HOBAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PEACE PIPE RD
LAC DU FLAMBEAU WI
54538-9123
US

IV. Provider business mailing address

PO BOX 189
LAC DU FLAMBEAU WI
54538-0189
US

V. Phone/Fax

Practice location:
  • Phone: 715-588-1511
  • Fax: 715-588-3903
Mailing address:
  • Phone: 715-588-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11558-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130338-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: