Provider Demographics
NPI:1225659659
Name:HILSCHER EVENSON, TESSA DIANA (LBSW)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:DIANA
Last Name:HILSCHER EVENSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8226
Mailing Address - Country:US
Mailing Address - Phone:701-241-5765
Mailing Address - Fax:701-241-5775
Practice Address - Street 1:1010 2ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8226
Practice Address - Country:US
Practice Address - Phone:701-241-5765
Practice Address - Fax:701-241-5775
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4077171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator