Provider Demographics
NPI:1306568092
Name:HILDRETH, KATELYNNE ELIZABETH (TLMHC)
Entity type:Individual
Prefix:
First Name:KATELYNNE
Middle Name:ELIZABETH
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 MORTIMER AVE
Mailing Address - Street 2:
Mailing Address - City:CALLENDER
Mailing Address - State:IA
Mailing Address - Zip Code:50523-5035
Mailing Address - Country:US
Mailing Address - Phone:641-340-0519
Mailing Address - Fax:
Practice Address - Street 1:720 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5759
Practice Address - Country:US
Practice Address - Phone:515-570-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid