Provider Demographics
NPI:1063940898
Name:HUSON, KACIE (LCSW)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:HUSON
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 1:850 SE ROSE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3942
Mailing Address - Country:US
Mailing Address - Phone:541-900-1506
Mailing Address - Fax:541-900-1507
Practice Address - Street 1:850 SE ROSE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3942
Practice Address - Country:US
Practice Address - Phone:541-900-1506
Practice Address - Fax:541-900-1507
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health