Provider Demographics
NPI:1851629620
Name:HILLENBRAND, MARK JOSEPH (LISW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOSEPH
Last Name:HILLENBRAND
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3775 EP TRUE PKWY
Mailing Address - Street 2:STE 119
Mailing Address - City:W DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7696
Mailing Address - Country:US
Mailing Address - Phone:515-277-0814
Mailing Address - Fax:515-255-9900
Practice Address - Street 1:4211 GRAND AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2423
Practice Address - Country:US
Practice Address - Phone:515-277-0814
Practice Address - Fax:515-255-9900
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA67241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical