Individual
KELLY ANNE SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
612 SE JACKSON ST STE 11, ROSEBURG, OR 97470-4956
(541) 464-6455
(541) 464-6457
Mailing address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4143
OR
Other
Enumeration date
02/21/2007
Last updated
04/15/2021
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