MEDICARE: ANGELA KRISTI SINCLAIR HAWLEY 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	1041C0700X	Clinical Social Worker	149.007940	IL

General Provider Information

NPI Number	:	1306136189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KRISTI SINCLAIR HAWLEY LCSW

Provider Business Mailing Address
First Line	:	119 STONECROP RD
Second Line	:
City	:	MORTON
State	:	IL
Zip	:	61550-3155
Country	:	US
Telephone Number	:	309-863-5590
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 N UNIVERSITY ST STE 101
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-4763
Country	:	US
Telephone Number	:	309-863-5590
Fax Number	:

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

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	12/19/2021

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