MEDICARE: MS. KELLY JO HAYES LCSW

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	COO3432	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154515138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY JO HAYES LCSW

Provider Business Mailing Address
First Line	:	5272 SWEETWATER CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-9770
Country	:	US
Telephone Number	:	336-451-9701
Fax Number	:

Provider Business Practice Location Address
First Line	:	5272 SWEETWATER CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-9770
Country	:	US
Telephone Number	:	336-451-9701
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	02/26/2014

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