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General NPI Number Information
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NPI Number | 1871292284
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Entity Type | Individual
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Provider Name | KELLY HILDRE MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 15 2ND ST NW
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City | BUFFALO
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State | MN
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Zip | 55313-1357
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Country | US
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Telephone | 763-612-2097
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Fax |
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Provider Business Mailing Address
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Address Line | 204 4TH AVE NW
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City | BUFFALO
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State | MN
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Zip | 55313-1019
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Country | US
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Telephone |
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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 |
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License Number State |
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