Provider Demographics
NPI:1962169151
Name:HIATT, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HIATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HIATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:418 E ROSSER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4046
Mailing Address - Country:US
Mailing Address - Phone:701-751-1220
Mailing Address - Fax:701-751-4050
Practice Address - Street 1:418 E ROSSER AVE STE 104
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4046
Practice Address - Country:US
Practice Address - Phone:701-751-1220
Practice Address - Fax:701-751-4050
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND45671041C0700X
SD4567104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical