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

Q: 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.

Q: What is Kelly Southern's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Kelly Southern was last updated on April 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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: August 16, 2026.

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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

Phone(541) 464-6455

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

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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.

GRACE LYNN WATKINS

Counselor