Provider Demographics
NPI:1033623301
Name:HILL, JODY LEA
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LEA
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TAMPICO RD
Mailing Address - Street 2:
Mailing Address - City:TULAROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88352-9693
Mailing Address - Country:US
Mailing Address - Phone:575-439-6706
Mailing Address - Fax:
Practice Address - Street 1:26 TAMPICO RD
Practice Address - Street 2:
Practice Address - City:TULAROSA
Practice Address - State:NM
Practice Address - Zip Code:88352-9693
Practice Address - Country:US
Practice Address - Phone:575-439-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician