MEDICARE: MS. MICHELLE MARIE HARDAWAY MSW

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	L11509	OR
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1558647594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE MARIE HARDAWAY MSW

Provider Business Mailing Address
First Line	:	8532 NE HANCOCK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5533
Country	:	US
Telephone Number	:	503-330-2514
Fax Number	:

Provider Business Practice Location Address
First Line	:	8532 NE HANCOCK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5533
Country	:	US
Telephone Number	:	503-330-2514
Fax Number	:

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

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	07/17/2024

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