Provider Demographics
NPI:1821039934
Name:BOBBERT, ALICE LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LYNN
Last Name:BOBBERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:LYNN
Other - Last Name:VISLOCKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:750 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6835
Mailing Address - Country:US
Mailing Address - Phone:570-455-6385
Mailing Address - Fax:570-861-1358
Practice Address - Street 1:750 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6835
Practice Address - Country:US
Practice Address - Phone:570-455-6385
Practice Address - Fax:570-861-1358
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123807104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker