Provider Demographics
NPI:1053341206
Name:HAWN, GLENNA M (LCSW)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:M
Last Name:HAWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 S BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-2985
Mailing Address - Country:US
Mailing Address - Phone:559-558-4051
Mailing Address - Fax:559-570-0118
Practice Address - Street 1:516 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1200
Practice Address - Country:US
Practice Address - Phone:559-594-4969
Practice Address - Fax:559-594-4308
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical