Provider Demographics
NPI:1356551907
Name:HEWITT, FAWN D (PSYD)
Entity type:Individual
Prefix:DR
First Name:FAWN
Middle Name:D
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 NW CORVETTE ST.
Mailing Address - Street 2:P.O. BOX 303
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-0303
Mailing Address - Country:US
Mailing Address - Phone:541-563-6649
Mailing Address - Fax:
Practice Address - Street 1:1918 NW CORVETTE ST.
Practice Address - Street 2:
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394
Practice Address - Country:US
Practice Address - Phone:541-563-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1670103TC0700X
OH3269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical