MEDICARE: REBECCA S HAWKINS PH.D

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	103G00000X	Clinical Neuropsychologist	2582	CO
2	103T00000X	Psychologist	2582	CO
3	103TC0700X	Clinical Psychologist	2582	CO

General Provider Information

NPI Number	:	1467418301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA S HAWKINS PH.D

Provider Business Mailing Address
First Line	:	4770 E ILIFF AVE STE 107
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-6049
Country	:	US
Telephone Number	:	303-830-1181
Fax Number	:	303-830-0270

Provider Business Practice Location Address
First Line	:	4770 E ILIFF AVE STE 107
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-6049
Country	:	US
Telephone Number	:	303-830-1181
Fax Number	:	303-830-0270

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	11/05/2012

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