MEDICARE: MISS ANNA KATHERINE HAIRSTON LSW

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

General Provider Information

NPI Number	:	1891215372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNA KATHERINE HAIRSTON LSW

Provider Business Mailing Address
First Line	:	3342 ELMSTONE CT
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44903-8424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 PUBLIC SQ FL 2
Second Line	:
City	:	GALION
State	:	OH
Zip	:	44833-1926
Country	:	US
Telephone Number	:	567-560-3583
Fax Number	:

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	06/26/2017

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