Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 715 | MN |
NPI | 1013332469 |
---|---|
Provider Name | Gretchen Hillesheim |
First Address | Willmar, MN 56201-5811 |
Second Address | Willmar, MN 56201-5811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2014 |
Last Update Date | 12/06/2019 |