Healthcare Provider Details

I. General information

NPI: 1053341206
Provider Name (Legal Business Name): GLENNA M HAWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

IV. Provider business mailing address

496 S BARTON AVE
FRESNO CA
93702-2985
US

V. Phone/Fax

Practice location:
  • Phone: 559-594-4969
  • Fax: 559-594-4308
Mailing address:
  • Phone: 559-558-4051
  • Fax: 559-570-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: