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NPI Code Detail

MEDICARE: CINDY JANELLE HACKETT MSW, LCSW

MEDICARE: CINDY JANELLE HACKETT MSW, LCSW
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1578669891
Entity Type Code : Individual
Provider Name (Legal Business Name) : CINDY JANELLE HACKETT MSW, LCSW
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 503-944-1203
Fax Number :
Provider Business Practice Location Address
First Line : 1825 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2844
Country : US
Telephone Number : 503-963-7676
Fax Number : 503-764-9042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 01/22/2020

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