Healthcare Provider Details

I. General information

NPI: 1003560699
Provider Name (Legal Business Name): HILLARY KATHERINE THEURER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

912 41ST AVE S
MOORHEAD MN
56560-7438
US

V. Phone/Fax

Practice location:
  • Phone: 701-333-8135
  • Fax:
Mailing address:
  • Phone: 701-333-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6336
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: