Provider Demographics
NPI:1891996179
Name:HAWLEY, LISA RUTH (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RUTH
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3605
Mailing Address - Country:US
Mailing Address - Phone:701-351-1182
Mailing Address - Fax:
Practice Address - Street 1:424 3RD ST SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3605
Practice Address - Country:US
Practice Address - Phone:701-351-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND28300OtherBCBS
ND19227Medicaid
ND30987OtherBCBS
ND30987OtherBCBS