Provider Demographics
NPI:1235968603
Name:HIATT, MICHELLE LYNNE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE
Last Name:HIATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 S YOSEMITE WAY UNIT 45
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2228
Mailing Address - Country:US
Mailing Address - Phone:303-340-3943
Mailing Address - Fax:
Practice Address - Street 1:1191 S YOSEMITE WAY UNIT 45
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2228
Practice Address - Country:US
Practice Address - Phone:303-340-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099282361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical