Healthcare Provider Details

I. General information

NPI: 1053957043
Provider Name (Legal Business Name): KATHERINE HILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 BROADWAY N
FARGO ND
58102-2622
US

IV. Provider business mailing address

1461 BROADWAY N
FARGO ND
58102-2622
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-6037
  • Fax: 701-293-0242
Mailing address:
  • Phone: 701-293-6037
  • Fax: 701-293-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3154
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: