Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003560699 |
---|---|
Provider Name | Hillary Katherine Theurer |
First Address | Moorhead, MN 56560-7438 |
Second Address | Moorhead, MN 56560-7438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2022 |
Last Update Date | 11/02/2022 |