Provider Demographics
NPI:1033355474
Name:FOLSTAD MILLER, HIEDI A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HIEDI
Middle Name:A
Last Name:FOLSTAD MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BURDICK EXPY E
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-5336
Mailing Address - Country:US
Mailing Address - Phone:701-720-7612
Mailing Address - Fax:866-221-5793
Practice Address - Street 1:3615 BURDICK EXPY E
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5336
Practice Address - Country:US
Practice Address - Phone:701-720-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid