Healthcare Provider Details

I. General information

NPI: 1023265212
Provider Name (Legal Business Name): JANET L. HAWF CACII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 BARNES AVE
LA JUNTA CO
81050-1329
US

IV. Provider business mailing address

711 BARNES AVE
LA JUNTA CO
81050-2138
US

V. Phone/Fax

Practice location:
  • Phone: 719-384-8503
  • Fax: 719-384-8411
Mailing address:
  • Phone: 719-384-5446
  • Fax: 719-384-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6598
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number23982
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: