Provider Demographics
NPI:1013538669
Name:HILLARD, JACOB BARRY
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:BARRY
Last Name:HILLARD
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 1:22415 SE 231ST ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5000
Mailing Address - Country:US
Mailing Address - Phone:425-906-4300
Mailing Address - Fax:
Practice Address - Street 1:22415 SE 231ST ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5000
Practice Address - Country:US
Practice Address - Phone:425-906-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician