Provider Demographics
NPI:1528208857
Name:HOBSON, KERRI C (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:C
Last Name:HOBSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14152 SW STARDUST LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2637
Mailing Address - Country:US
Mailing Address - Phone:503-539-1697
Mailing Address - Fax:
Practice Address - Street 1:14152 SW STARDUST LN
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2637
Practice Address - Country:US
Practice Address - Phone:503-539-1697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11573171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor