MEDICARE: SHALAE N HESSELBEIN 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	8355-C	AR
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790152999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALAE N HESSELBEIN LCSW

Provider Business Mailing Address
First Line	:	2908 WATERFRONT CV
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-8041
Country	:	US
Telephone Number	:	501-920-9625
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W BROADWAY ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5628
Country	:	US
Telephone Number	:	501-487-1558
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	04/14/2023

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