MEDICARE: MS. JESSICA HAWLEY

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1639964174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA HAWLEY

Provider Business Mailing Address
First Line	:	1661 VIA ALTA MESA
Second Line	:
City	:	NIPOMO
State	:	CA
Zip	:	93444-9344
Country	:	US
Telephone Number	:	805-474-3670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 VIA ALTA MESA
Second Line	:
City	:	NIPOMO
State	:	CA
Zip	:	93444-9344
Country	:	US
Telephone Number	:	805-474-3670
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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