MEDICARE: W. LAURA HAWK PH.D.

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	103T00000X	Psychologist	23506	TX

General Provider Information

NPI Number	:	1417064395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	W. LAURA HAWK PH.D.

Provider Business Mailing Address
First Line	:	5068 W PLANO PKWY
Second Line	:	SUITE 196
City	:	PLANO
State	:	TX
Zip	:	75093-4408
Country	:	US
Telephone Number	:	972-931-6711
Fax Number	:	972-931-9890

Provider Business Practice Location Address
First Line	:	5068 W PLANO PKWY
Second Line	:	SUITE 196
City	:	PLANO
State	:	TX
Zip	:	75093-4408
Country	:	US
Telephone Number	:	972-931-1167
Fax Number	:	972-931-9890

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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Directions to “ W. LAURA HAWK PH.D.” Practice Location

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