Provider Demographics
NPI:1275830713
Name:HAWKINS, HEATHER MICHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 OAK ST SE BLDG C
Mailing Address - Street 2:P.O. BOX 14001
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3905
Mailing Address - Country:US
Mailing Address - Phone:503-561-3133
Mailing Address - Fax:503-561-1495
Practice Address - Street 1:890 OAK ST SE BLDG C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3905
Practice Address - Country:US
Practice Address - Phone:503-561-3133
Practice Address - Fax:503-561-1495
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 104100000X
ORL65331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No372600000XNursing Service Related ProvidersAdult Companion
No104100000XBehavioral Health & Social Service ProvidersSocial Worker