Provider Demographics
NPI:1093886673
Name:HILDEBRANDT, DAVID EARL (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EARL
Last Name:HILDEBRANDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6275
Mailing Address - Country:US
Mailing Address - Phone:507-385-6574
Mailing Address - Fax:507-385-6511
Practice Address - Street 1:100 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6275
Practice Address - Country:US
Practice Address - Phone:507-385-6574
Practice Address - Fax:507-385-6511
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical