Healthcare Provider Details

I. General information

NPI: 1497776272
Provider Name (Legal Business Name): JANET L HAWTHORNE PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROCK RD SUITE 365
WICHITA KS
67206-2243
US

IV. Provider business mailing address

250 N ROCK RD SUITE 365
WICHITA KS
67206-2243
US

V. Phone/Fax

Practice location:
  • Phone: 316-719-3875
  • Fax: 316-719-3877
Mailing address:
  • Phone: 316-719-3875
  • Fax: 316-719-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0863
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: