MEDICARE: PHILIP GREGG HIRES MSSW, LSW

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	LW00004987	WA

General Provider Information

NPI Number	:	1356311856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP GREGG HIRES MSSW, LSW

Provider Business Mailing Address
First Line	:	PO BOX 8051
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98908-0051
Country	:	US
Telephone Number	:	509-469-1903
Fax Number	:	509-469-1905

Provider Business Practice Location Address
First Line	:	134 FLYING H LOOP
Second Line	:
City	:	NACHES
State	:	WA
Zip	:	98937-9168
Country	:	US
Telephone Number	:	509-658-2992
Fax Number	:	509-697-4712

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	01/08/2008

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