Provider Demographics
NPI:1265686133
Name:HIEB, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HIEB
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 SECOND STREET SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3924
Mailing Address - Country:US
Mailing Address - Phone:701-857-4410
Mailing Address - Fax:701-857-4413
Practice Address - Street 1:215 SECOND STREET SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3924
Practice Address - Country:US
Practice Address - Phone:701-857-4410
Practice Address - Fax:701-857-4413
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55320Medicaid