MEDICARE: MRS. FRANCES M HACKNEY 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	1041C0700X	Clinical Social Worker	6801005399	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0890381	OTHER	MI	BLUE CROSS POS
2	457616000	OTHER	MI	MAGELLAN

General Provider Information

NPI Number	:	1477652568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FRANCES M HACKNEY LMSW

Provider Business Mailing Address
First Line	:	5123 W. ST JOSEPH HWY.
Second Line	:	SUITE 103
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-323-4099
Fax Number	:	517-323-3334

Provider Business Practice Location Address
First Line	:	5123 W. ST JOSEPH HWY.
Second Line	:	SUITE 103
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-323-4099
Fax Number	:	517-323-3334

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/18/2013

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