Provider Demographics
NPI:1033237383
Name:HEPP, JILL (BS,PT CEIS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HEPP
Suffix:
Gender:F
Credentials:BS,PT CEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W SKY LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6774
Mailing Address - Country:US
Mailing Address - Phone:518-207-6519
Mailing Address - Fax:518-383-9301
Practice Address - Street 1:23 W SKY LN
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6774
Practice Address - Country:US
Practice Address - Phone:518-207-6519
Practice Address - Fax:518-383-9301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024925-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist