Provider Demographics
NPI:1366735854
Name:HYLLA, STEPHANIE LYNN (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:HYLLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S FRONT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3887
Mailing Address - Country:US
Mailing Address - Phone:507-388-6829
Mailing Address - Fax:507-388-1963
Practice Address - Street 1:709 S FRONT ST STE 5
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3887
Practice Address - Country:US
Practice Address - Phone:507-388-6829
Practice Address - Fax:507-388-1963
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist