MEDICARE: MR. HANZ WILLIAM BOLEN MSW

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	LCS12588	CA

General Provider Information

NPI Number	:	1235223892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HANZ WILLIAM BOLEN MSW

Provider Business Mailing Address
First Line	:	2030 9TH AVENUE
Second Line	:	SUITE 210
City	:	SEATTLE
State	:	WA
Zip	:	98121
Country	:	US
Telephone Number	:	206-277-3564
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 9TH AVENUE
Second Line	:	SUITE 210
City	:	SEATTLE
State	:	WA
Zip	:	98121
Country	:	US
Telephone Number	:	206-277-3564
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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