Provider Demographics
NPI:1538224100
Name:HAWLEY, JESSICA JEWEL (ATC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEWEL
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 W 98TH ST APT 325
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2131
Mailing Address - Country:US
Mailing Address - Phone:952-220-1879
Mailing Address - Fax:
Practice Address - Street 1:6025 109TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3475
Practice Address - Country:US
Practice Address - Phone:952-220-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other