Provider Demographics
NPI:1003667197
Name:HAWKINS, CALLEIGH BRENNA
Entity Type:Individual
Prefix:
First Name:CALLEIGH
Middle Name:BRENNA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 N TARRANT PKWY STE 152
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7300
Mailing Address - Country:US
Mailing Address - Phone:817-514-6333
Mailing Address - Fax:
Practice Address - Street 1:5310 N TARRANT PKWY STE 152
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7300
Practice Address - Country:US
Practice Address - Phone:817-514-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist