MEDICARE: BETH MARIE HAWKINS LCSW,MAC,CAADC,CCJP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	24915	IL
2	1041C0700X	Clinical Social Worker	149.013243	IL

General Provider Information

NPI Number	:	1487211074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH MARIE HAWKINS LCSW,MAC,CAADC,CCJP

Provider Business Mailing Address
First Line	:	2319 PLAINFIELD RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-1875
Country	:	US
Telephone Number	:	815-260-7203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 PLAINFIELD RD
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-1875
Country	:	US
Telephone Number	:	815-260-7203
Fax Number	:

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

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	07/30/2019

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