Phillip Hathaway, LMSW

NPI #1316507296 in Rexburg, Idaho

Provider Information

NPI Number: 1316507296
Entity Type: Individual
Name: Phillip Hathaway, LMSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker - Clinical
Credential: LMSW
Enumeration Date: Jun 13, 2019
Last Updated: Jun 13, 2019

Practice Location

Address: 253 S 2ND E BSMT
City: Rexburg
State: Idaho
ZIP Code: 83440-2202
Phone: (253) 232-3957

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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