Provider Demographics
NPI:1891449450
Name:HILT, LORI MICHELLE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MICHELLE
Last Name:HILT
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E BOLDT WAY
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5690
Mailing Address - Country:US
Mailing Address - Phone:920-832-7050
Mailing Address - Fax:
Practice Address - Street 1:612 E LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2155
Practice Address - Country:US
Practice Address - Phone:920-659-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical