Provider Demographics
NPI:1225793532
Name:HIEMENZ, TIFFANY MANE EMSLANDER
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MANE EMSLANDER
Last Name:HIEMENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N BENTON DR
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379
Mailing Address - Country:US
Mailing Address - Phone:320-281-2030
Mailing Address - Fax:320-529-0747
Practice Address - Street 1:215 N BENTON DR
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379
Practice Address - Country:US
Practice Address - Phone:320-281-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker