Provider Demographics
NPI:1548241581
Name:HITTNER, JO A (PHD LP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:HITTNER
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:JO
Other - Middle Name:A
Other - Last Name:GUNDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD LP
Mailing Address - Street 1:166 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3405
Mailing Address - Country:US
Mailing Address - Phone:507-454-4341
Mailing Address - Fax:507-453-6267
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3405
Practice Address - Country:US
Practice Address - Phone:507-454-4341
Practice Address - Fax:507-453-6267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38123GUOtherBCBS
MN117929OtherU CARE