Healthcare Provider Details

I. General information

NPI: 1306114681
Provider Name (Legal Business Name): JENNIFER HILLWIG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ARCH ST
CONNELLSVILLE PA
15425-3515
US

IV. Provider business mailing address

315 HALDEMAN DR
CRANBERRY TWP PA
16066-5629
US

V. Phone/Fax

Practice location:
  • Phone: 724-626-9941
  • Fax: 724-626-2785
Mailing address:
  • Phone: 724-448-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005762
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: