Provider Demographics
NPI:1104563808
Name:HOBAN, BRIANA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:JEAN
Last Name:HOBAN
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0189
Mailing Address - Country:US
Mailing Address - Phone:715-588-1511
Mailing Address - Fax:
Practice Address - Street 1:533 PEACE PIPE RD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-9123
Practice Address - Country:US
Practice Address - Phone:715-588-1511
Practice Address - Fax:715-588-3903
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11558-1231041C0700X
251S00000X
WI130338-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104563808Medicaid
WI11558-123OtherSTATE LICENSURE