Provider Demographics
NPI:1164609665
Name:ZABLOCKI, JILL M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:ZABLOCKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3224
Mailing Address - Country:US
Mailing Address - Phone:801-875-1926
Mailing Address - Fax:646-843-4713
Practice Address - Street 1:574 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-3224
Practice Address - Country:US
Practice Address - Phone:801-875-1926
Practice Address - Fax:646-843-4713
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017071103TC0700X
NJ5088103TC0700X
UT9226522-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical