1588706865 NPI number — MS. ILYSE L HILDEBRAND LCSW, ACSW

Table of content: MS. ILYSE L HILDEBRAND LCSW, ACSW (NPI 1588706865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588706865 NPI number — MS. ILYSE L HILDEBRAND LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILDEBRAND
Provider First Name:
ILYSE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588706865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5806 INDIANOLA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46220-2775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-466-1621
Provider Business Mailing Address Fax Number:
317-595-9811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8626 SOUTH ST.
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-595-9811
Provider Business Practice Location Address Fax Number:
317-595-9811
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34004051A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000258150 . This is a "INSURANCE CARRIER PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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