MEDICARE: CARRIE MICHELLE HEDINGER

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	1041C0700X	Clinical Social Worker	52557	TX

General Provider Information

NPI Number	:	1306407507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MICHELLE HEDINGER

Provider Business Mailing Address
First Line	:	6801 MILLIKIN CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-2245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 E MAIN ST STE 102
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5220
Country	:	US
Telephone Number	:	512-577-4666
Fax Number	:

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	06/27/2019

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