MEDICARE: MRS. CYNTHIA K HACK LMSW, CSW

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	6801082328	MI

General Provider Information

NPI Number	:	1255393153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA K HACK LMSW, CSW

Provider Business Mailing Address
First Line	:	200 S WENONA ST
Second Line	:	SUITE G29
City	:	BAY CITY
State	:	MI
Zip	:	48706-8820
Country	:	US
Telephone Number	:	989-893-3212
Fax Number	:	989-893-0461

Provider Business Practice Location Address
First Line	:	200 S WENONA ST
Second Line	:	SUITE G29
City	:	BAY CITY
State	:	MI
Zip	:	48706-8820
Country	:	US
Telephone Number	:	989-893-3212
Fax Number	:	989-893-0461

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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