Provider Demographics
NPI:1720827058
Name:KOLSTAD, HILARI DIANA
Entity type:Individual
Prefix:
First Name:HILARI
Middle Name:DIANA
Last Name:KOLSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HILARI
Other - Middle Name:DIANA
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66184 E SPRINGBROOK ST
Practice Address - Street 2:
Practice Address - City:WELCHES
Practice Address - State:OR
Practice Address - Zip Code:97067-7000
Practice Address - Country:US
Practice Address - Phone:503-804-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician