Individual
KENNETH HILLIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 E RUDISILL BLVD STE B102, FORT WAYNE, IN 46806-1756
(126) 079-7589
Mailing address
921 E DUPONT RD # 909, FORT WAYNE, IN 46825-1551
(260) 797-5892
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
03/23/2022
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