Healthcare Provider Details

I. General information

NPI: 1710642723
Provider Name (Legal Business Name): MADELINE HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE GAZAREK

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 OKEMOS RD
MASON MI
48854-9401
US

IV. Provider business mailing address

201 W ASH ST STE 2A
MASON MI
48854-1513
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-6499
  • Fax:
Mailing address:
  • Phone: 517-888-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801120004
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851109660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: