Provider Demographics
NPI:1336641505
Name:HAWK, KAREN (PSYD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HAWK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3538 E POWELL WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4807
Mailing Address - Country:US
Mailing Address - Phone:480-218-2289
Mailing Address - Fax:
Practice Address - Street 1:3538 E POWELL WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4807
Practice Address - Country:US
Practice Address - Phone:480-218-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1336641505OtherAZ BLUE CROSS BLUE SHIELD