KELLY ANNE SOUTHERN MSW
NPI 1871638296
Social Worker - Clinical in Roseburg, OR

Active since February 21, 2007
612 SE JACKSON ST STE 11, ROSEBURG, OR 97470(541) 464-6455(541) 464-6457 Get Directions Write a Review

NPPES record last updated: April 15, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kelly Anne Southern Msw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY ANNE SOUTHERN MSW (NPI 1871638296) is an individual clinical provider in Roseburg, Oregon, licensed in Oregon (4143) and active in the NPI registry since February 2007.

NPPES Registry Identity

NPI1871638296
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKELLY ANNE SOUTHERNCredential: MSW
Location Address612 SE JACKSON ST STE 11Roseburg, OR 97470-4956
Mailing Address913 Nw Garden Valley BlvdRoseburg, OR 97471-6523 · (541) 440-1000
Fax(541) 464-6457
Sole ProprietorNo
Enumeration DateFebruary 21, 2007
Last NPPES UpdateApril 15, 2021
NPPES CertifiedApril 15, 2021
NPI 1871638296 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in OR · 4143
Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

612 SE JACKSON ST STE 11, Roseburg, OR 97470

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Social Worker (Clinical)
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470
Counselor
612 SE JACKSON ST STE 11
ROSEBURG, OR 97470

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Southern's NPI number?

The NPI number for Kelly Southern is 1871638296. It was assigned to this individual provider in the NPPES registry on February 21, 2007.

Where is Kelly Southern located?

Kelly Southern practices at 612 SE Jackson St Ste 11, Roseburg, OR 97470. The listed phone number is (541) 464-6455.

What is Kelly Southern's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Kelly Southern was last updated on April 15, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.