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NPI Code Detail

MEDICARE: LINDA HYLLA LCSW

MEDICARE:   LINDA  HYLLA  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149006759IL

General Provider Information

NPI Number : 1295855310
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA HYLLA LCSW
Provider Business Mailing Address
First Line : 1003 MARTIN LUTHER KING DR
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61701-1429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 NORTHGATE INDUSTRIAL DR
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-6805
Country : US
Telephone Number : 618-877-4420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 05/21/2019

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Directions to “ LINDA HYLLA LCSW” Practice Location

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