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NPI Code Detail

MEDICARE: CONNIE JENNIE LYNN HAWLEY LCSW

MEDICARE: CONNIE JENNIE LYNN 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
11041C0700XClinical Social Worker34007549AIN

General Provider Information

NPI Number : 1417242355
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE JENNIE LYNN HAWLEY LCSW
Provider Business Mailing Address
First Line : 240 N TILLOTSON AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47304-3988
Country : US
Telephone Number : 765-288-1928
Fax Number : 765-741-0335
Provider Business Practice Location Address
First Line : 2000 WERNLE RD RM B6
Second Line :
City : RICHMOND
State : IN
Zip : 47374-7015
Country : US
Telephone Number : 765-288-1928
Fax Number : 765-741-0335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2011
Last Update Date : 05/25/2016

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