Provider Demographics
NPI:1548854151
Name:HILTY, MADISON KATHRYNE (BA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:KATHRYNE
Last Name:HILTY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 STONE VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6991
Mailing Address - Country:US
Mailing Address - Phone:702-488-9166
Mailing Address - Fax:
Practice Address - Street 1:1547 STONE VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6991
Practice Address - Country:US
Practice Address - Phone:702-488-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician