Provider Demographics
NPI:1770926065
Name:HAWBOLT, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HAWBOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 SW CENTER ST.
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3940 SW PLUM ST
Practice Address - Street 2:APT#2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6027
Practice Address - Country:US
Practice Address - Phone:503-484-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor