Provider Demographics
NPI:1770593568
Name:HAWK, JOANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:HAWK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2235 CHALLENGER WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5458
Mailing Address - Country:US
Mailing Address - Phone:707-576-7057
Mailing Address - Fax:707-576-1964
Practice Address - Street 1:2235 CHALLENGER WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5458
Practice Address - Country:US
Practice Address - Phone:707-576-7057
Practice Address - Fax:707-576-1964
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL86410Medicare ID - Type Unspecified