MEDICARE: MS. VICKI JO HAWKINS 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	6801065745	MI

General Provider Information

NPI Number	:	1689615338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI JO HAWKINS LMSW

Provider Business Mailing Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	SUITE 104
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-887-9801
Fax Number	:	517-887-9826

Provider Business Practice Location Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	SUITE 104
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-887-9801
Fax Number	:	517-887-9826

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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