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NPI Code Detail

MEDICARE: DR. GRACE KATHERINE HAWLEY PSYD

MEDICARE: DR. GRACE KATHERINE HAWLEY PSYD
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
1101YM0800XMental Health Counselor
2103T00000XPsychologist2023020843MO
3103TC0700XClinical Psychologist2023020843MO

General Provider Information

NPI Number : 1336674712
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACE KATHERINE HAWLEY PSYD
Provider Business Mailing Address
First Line : 255 SPENCER RD STE 101
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2574
Country : US
Telephone Number : 503-962-0052
Fax Number :
Provider Business Practice Location Address
First Line : 255 SPENCER RD STE 101
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2574
Country : US
Telephone Number : 503-962-0052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2017
Last Update Date : 08/26/2025

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