Provider Demographics
NPI:1679037733
Name:KOBLISKA, KAREN JOELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JOELLE
Last Name:KOBLISKA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 N TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-4026
Mailing Address - Country:US
Mailing Address - Phone:916-223-2047
Mailing Address - Fax:
Practice Address - Street 1:489 N TACOMA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-4026
Practice Address - Country:US
Practice Address - Phone:916-223-2047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty