MEDICARE: EMILY JANE HAWKINS 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	1041C0700X	Clinical Social Worker	3083029-3501	UT

General Provider Information

NPI Number	:	1356672810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JANE HAWKINS LCSW

Provider Business Mailing Address
First Line	:	2670 S 2000 E STE 203
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1783
Country	:	US
Telephone Number	:	801-960-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 S 2000 E STE 203
Second Line	:	SUITE 11
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1783
Country	:	US
Telephone Number	:	801-960-2550
Fax Number	:	801-550-9757

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	04/26/2017

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