MEDICARE: CYNTHIA A HUNT 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	1041C0700X	Clinical Social Worker	7633-123	WI

General Provider Information

NPI Number	:	1619295276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA A HUNT LCSW

Provider Business Mailing Address
First Line	:	505 S DEWEY ST STE 106
Second Line	:	BOX 17
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-3781
Country	:	US
Telephone Number	:	715-835-5110
Fax Number	:	715-835-8414

Provider Business Practice Location Address
First Line	:	505 S DEWEY ST STE 106
Second Line	:	BOX 17
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-3781
Country	:	US
Telephone Number	:	715-835-5110
Fax Number	:	715-835-8414

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	06/07/2011

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