MEDICARE: GRETCHEN HILLESHEIM LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	715	MN

General Provider Information

NPI Number	:	1013332469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN HILLESHEIM LPCC

Provider Business Mailing Address
First Line	:	2320 HIGHWAY 12 E STE 2
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-5811
Country	:	US
Telephone Number	:	320-214-9692
Fax Number	:	320-214-9924

Provider Business Practice Location Address
First Line	:	2320 HIGHWAY 12 E STE 2
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-5811
Country	:	US
Telephone Number	:	320-214-9692
Fax Number	:	320-214-9924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	06/12/2019

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