Provider Demographics
NPI:1164168647
Name:HILL, TRAVILLYA
Entity Type:Individual
Prefix:
First Name:TRAVILLYA
Middle Name:
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 1:12003 S PULASKI RD # 327
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1221
Mailing Address - Country:US
Mailing Address - Phone:708-297-0022
Mailing Address - Fax:
Practice Address - Street 1:12744 S KENNETH AVE UNIT 3SE
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-2838
Practice Address - Country:US
Practice Address - Phone:708-297-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.107565104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker