MEDICARE: CYNTHIA HOGARTY S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	922	MT

General Provider Information

NPI Number	:	1013339365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA HOGARTY S.W.

Provider Business Mailing Address
First Line	:	1903 S RUSSELL ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-6603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 S RUSSELL ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-6603
Country	:	US
Telephone Number	:	406-532-1615
Fax Number	:	406-232-1616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/06/2014

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