Provider Demographics
NPI:1275840365
Name:HILL, DEIDRA MICHELLE (BA, MA)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:MICHELLE
Last Name:HILL
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 E 50TH ST
Mailing Address - Street 2:APARTMENT #22B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3128
Mailing Address - Country:US
Mailing Address - Phone:708-825-7584
Mailing Address - Fax:773-487-9062
Practice Address - Street 1:1649 E 50TH ST
Practice Address - Street 2:APARTMENT #22B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3128
Practice Address - Country:US
Practice Address - Phone:708-825-7584
Practice Address - Fax:773-487-9062
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist