Provider Demographics
NPI:1922425636
Name:HAWKS, JILLIAN (MS)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:HAWKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SHAKER DR
Mailing Address - Street 2:#322
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 SHAKER DR
Practice Address - Street 2:#322
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3745
Practice Address - Country:US
Practice Address - Phone:859-412-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2012-023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist