Provider Demographics
NPI:1043438658
Name:HILL, AUDRA (MSW/CSW-PIP)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:MSW/CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 RED DALE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3231
Mailing Address - Country:US
Mailing Address - Phone:605-381-0049
Mailing Address - Fax:
Practice Address - Street 1:316 MIDDLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2381
Practice Address - Country:US
Practice Address - Phone:605-381-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD21251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical