MEDICARE: TRAVIS JAY HAYES LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	28786	MN

General Provider Information

NPI Number	:	1144070095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS JAY HAYES LICSW

Provider Business Mailing Address
First Line	:	7307 W FRANKLIN AVE
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2013
Country	:	US
Telephone Number	:	701-213-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	7307 W FRANKLIN AVE
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2013
Country	:	US
Telephone Number	:	701-213-9544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/12/2026

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