Provider Demographics
NPI:1124387592
Name:HOVLAND, ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HOVLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 SW RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1783
Mailing Address - Country:US
Mailing Address - Phone:541-257-5500
Mailing Address - Fax:541-286-4140
Practice Address - Street 1:4185 SW RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1783
Practice Address - Country:US
Practice Address - Phone:541-257-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL34581041C0700X
ORL24581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646073Medicaid
OR500646073Medicaid