MEDICARE: KRISTIN ELIZABETH HAJNY 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
1	1041C0700X	Clinical Social Worker	L3704	OR

General Provider Information

NPI Number	:	1598372070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELIZABETH HAJNY LCSW

Provider Business Mailing Address
First Line	:	7805 SW 40TH AVE UNIT 80381
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97280-2404
Country	:	US
Telephone Number	:	503-482-8561
Fax Number	:

Provider Business Practice Location Address
First Line	:	7805 SW 40TH AVENUE #80381
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-9721
Country	:	US
Telephone Number	:	503-482-8561
Fax Number	:

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

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	05/08/2021

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