Provider Demographics
NPI:1003208356
Name:HILL, EDD
Entity Type:Individual
Prefix:
First Name:EDD
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24248 STATE ROAD 35 70
Mailing Address - Street 2:UNIT D
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-5001
Mailing Address - Country:US
Mailing Address - Phone:715-349-7233
Mailing Address - Fax:715-349-7205
Practice Address - Street 1:24248 STATE ROAD 35 70
Practice Address - Street 2:UNIT D
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-5001
Practice Address - Country:US
Practice Address - Phone:715-349-7233
Practice Address - Fax:715-349-7205
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI872-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist