Provider Demographics
NPI:1417377920
Name:HASTINGS, MARY ANN (MSA-LSW)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MSA-LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-0190
Mailing Address - Country:US
Mailing Address - Phone:701-636-5220
Mailing Address - Fax:701-636-5221
Practice Address - Street 1:114 WEST CALEDONIA AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045
Practice Address - Country:US
Practice Address - Phone:701-636-5220
Practice Address - Fax:701-636-5221
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND79390Medicaid