Individual
MATTHEW HAWTHORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
322 FRONTIER BLVD, STANFORD, KY 40484-7730
(606) 365-2197
Mailing address
322 FRONTIER BLVD, STANFORD, KY 40484-7730
(606) 365-2197
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
07/17/2014
Last updated
07/17/2014
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