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General NPI Number Information
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NPI Number | 1851629620
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Entity Type | Individual
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Provider Name | MARK JOSEPH HILLENBRAND LISW
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Gender | Male
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Dates
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Enumeration Date | 12/05/2009
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 4211 GRAND AVE SUITE 12
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City | DES MOINES
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State | IA
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Zip | 50312-2423
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Country | US
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Telephone | 515-277-0814
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Fax | 515-255-9900
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Provider Business Mailing Address
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Address Line | 3775 EP TRUE PKWY STE 119
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City | W DES MOINES
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State | IA
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Zip | 50265-7696
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Country | US
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Telephone | 515-277-0814
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Fax | 515-255-9900
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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 | 6724
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License Number State | IA
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