Provider Demographics
NPI:1053047159
Name:HILLERUD, KATELYN (BS)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:HILLERUD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HILLERUD/NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:1400 MADISON AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5465
Mailing Address - Country:US
Mailing Address - Phone:507-702-3030
Mailing Address - Fax:
Practice Address - Street 1:1400 MADISON AVE STE 322
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5465
Practice Address - Country:US
Practice Address - Phone:507-702-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health