Provider Demographics
NPI:1093449191
Name:HOCKENBROCH, OLIVIA (SWLC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:HOCKENBROCH
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3138
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-3138
Mailing Address - Country:US
Mailing Address - Phone:717-525-0074
Mailing Address - Fax:
Practice Address - Street 1:3819 STEPHENS AVE STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8522
Practice Address - Country:US
Practice Address - Phone:406-215-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-566391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-SWLC-LIC-56639OtherSWLC