Healthcare Provider Details

I. General information

NPI: 1689747537
Provider Name (Legal Business Name): JO ANN HASTY LCSW, ACSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W TENNESSEE AVE
OAK RIDGE TN
37830-6503
US

IV. Provider business mailing address

240 W TENNESSEE AVE
OAK RIDGE TN
37830-6503
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-1337
  • Fax: 865-482-1360
Mailing address:
  • Phone: 865-482-1337
  • Fax: 865-482-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number217
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: