MEDICARE: NANCY STEUBEN HAWFIELD CCC-SLP

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	235Z00000X	Speech-Language Pathologist	146.001223	IL
2	235Z00000X	Speech-Language Pathologist	2202005701	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004932108	OTHER	IL	FOR BC/BS IL
2	NH57971004P	OTHER	IL	EARLY INTERVENTION IL

General Provider Information

NPI Number	:	1619929213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY STEUBEN HAWFIELD CCC-SLP

Provider Business Mailing Address
First Line	:	3332 RUNNING CEDAR WAY
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2465
Country	:	US
Telephone Number	:	757-208-0086
Fax Number	:	757-208-0087

Provider Business Practice Location Address
First Line	:	3332 RUNNING CEDAR WAY
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2465
Country	:	US
Telephone Number	:	757-208-0086
Fax Number	:	757-208-0087

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/15/2009

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