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1871638296
KELLY ANNE SOUTHERN
ROSEBURG, OR
NPI
1871638296
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: OR 4143)
Enumeration Date
2007-02-21
Last Update Date
2021-04-15
Business Address
KELLY ANNE SOUTHERN MSW
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470-4956
Phone number: 541-464-6455
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Mailing Address
KELLY ANNE SOUTHERN MSW
913 NW GARDEN VALLEY BLVD
ROSEBURG, OR 97471-6523
Phone number: 541-440-1000
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