Provider Demographics
NPI:1609594878
Name:HAWKINSON, JADEN (ND, LAC)
Entity Type:Individual
Prefix:
First Name:JADEN
Middle Name:
Last Name:HAWKINSON
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 PASTORAL PL
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3735
Mailing Address - Country:US
Mailing Address - Phone:303-552-8494
Mailing Address - Fax:
Practice Address - Street 1:125 KALLOF PL
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5566
Practice Address - Country:US
Practice Address - Phone:928-204-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1707175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath