Healthcare Provider Details

I. General information

NPI: 1043438658
Provider Name (Legal Business Name): AUDRA HILL MSW/CSW-PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MIDDLE VALLEY DR
RAPID CITY SD
57701-2381
US

IV. Provider business mailing address

1929 RED DALE DR
RAPID CITY SD
57702-3231
US

V. Phone/Fax

Practice location:
  • Phone: 605-381-0049
  • Fax:
Mailing address:
  • Phone: 605-381-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2125
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: