MEDICARE: MS. RENEE DIANE HATTEN 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
1	104100000X	Social Worker	LCSW844	ID

General Provider Information

NPI Number	:	1558429688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE DIANE HATTEN LCSW

Provider Business Mailing Address
First Line	:	1408 W HAYS ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-0000
Country	:	US
Telephone Number	:	208-321-7735
Fax Number	:	208-336-7125

Provider Business Practice Location Address
First Line	:	1408 W HAYS ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-0000
Country	:	US
Telephone Number	:	208-321-7735
Fax Number	:	208-336-7125

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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