Provider Demographics
NPI:1316569924
Name:HITTNER, HILLARY GRACE (LADC)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:GRACE
Last Name:HITTNER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2825
Mailing Address - Country:US
Mailing Address - Phone:218-755-5050
Mailing Address - Fax:
Practice Address - Street 1:419 3RD ST E
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2104
Practice Address - Country:US
Practice Address - Phone:218-755-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)