MEDICARE: KATHLEEN RAE HAWK LMSW

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	104100000X	Social Worker	03179	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	420681060A9	OTHER	IA	JOHN DEERE HEALTH
2	I020	OTHER	IA	TRIWEST
3	207475	OTHER	IA	IOWA HEALTH SOLUTIONS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	420681060A9	OTHER	IA	UNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1427041011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN RAE HAWK LMSW

Provider Business Mailing Address
First Line	:	312 E ALTA VISTA AVE
Second Line	:	BEHAVIORAL HEALTH COUNSELING SERVICES
City	:	OTTUMWA
State	:	IA
Zip	:	52501-1413
Country	:	US
Telephone Number	:	641-684-3135
Fax Number	:	641-684-3198

Provider Business Practice Location Address
First Line	:	312 E ALTA VISTA AVE
Second Line	:	BEHAVIORAL HEALTH COUNSELING SERVICES
City	:	OTTUMWA
State	:	IA
Zip	:	52501-1413
Country	:	US
Telephone Number	:	641-684-3135
Fax Number	:	641-684-3198

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	10/16/2007

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Directions to “ KATHLEEN RAE HAWK LMSW” Practice Location

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