Provider Demographics
NPI:1205553286
Name:HAWKINSON, KASEY (LAC)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:HAWKINSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 N 94TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4242
Mailing Address - Country:US
Mailing Address - Phone:623-487-7763
Mailing Address - Fax:623-486-8276
Practice Address - Street 1:13260 N 94TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4242
Practice Address - Country:US
Practice Address - Phone:623-487-7763
Practice Address - Fax:623-486-8276
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23782101YP2500X
AZ21079101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional