Provider Demographics
NPI:1326394255
Name:MANTZ, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MANTZ
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 1:206 WASHINGTON CT
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2235
Mailing Address - Country:US
Mailing Address - Phone:484-902-8512
Mailing Address - Fax:
Practice Address - Street 1:3075 W RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-1534
Practice Address - Country:US
Practice Address - Phone:610-265-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst