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General NPI Number Information
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NPI Number | 1689722985
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Entity Type | Individual
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Provider Name | DIETRAH CHAPMAN HIATT MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1919 UNIVERSITY AVE W SUITE 200
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City | SAINT PAUL
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State | MN
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Zip | 55104-3453
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Country | US
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Telephone | 651-266-7932
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 CHOWEN AVE S APT 326
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-4534
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Country | US
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Telephone | 612-362-0104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13950
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License Number State | MN
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