Provider Demographics
NPI:1093222127
Name:HAWKS, STACY ANN
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:HAWKS
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 1:986 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3560
Mailing Address - Country:US
Mailing Address - Phone:801-669-2991
Mailing Address - Fax:
Practice Address - Street 1:986 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3560
Practice Address - Country:US
Practice Address - Phone:801-669-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health