Healthcare Provider Details

I. General information

NPI: 1619704319
Provider Name (Legal Business Name): SAMANTHA HAWKEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S BRENTWOOD BLVD STE 205
SAINT LOUIS MO
63144-1315
US

IV. Provider business mailing address

909 OAKWOOD FARMS LN
BALLWIN MO
63021-7907
US

V. Phone/Fax

Practice location:
  • Phone: 314-881-0350
  • Fax:
Mailing address:
  • Phone: 314-409-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2023037352
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: