MEDICARE: CHRISTINA HAWKESWORTH

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1346494721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA HAWKESWORTH

Provider Business Mailing Address
First Line	:	PO BOX 7692
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-7692
Country	:	US
Telephone Number	:	773-574-8056
Fax Number	:	773-913-2527

Provider Business Practice Location Address
First Line	:	1433 W FLOURNOY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3205
Country	:	US
Telephone Number	:	773-574-8056
Fax Number	:	773-913-2527

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	08/06/2009

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Directions to “ CHRISTINA HAWKESWORTH ” Practice Location

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