Provider Demographics
NPI:1003205543
Name:HILL, JAMIE LYN (BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:HILL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:317-449-4833
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:6635 EAST 21ST STREET
Practice Address - Street 2:SUITE 100 WEST BLDG
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2254
Practice Address - Country:US
Practice Address - Phone:317-608-2824
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-14-17717103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-17717OtherBCBA CERTIFICATION