Provider Demographics
NPI:1407593395
Name:SHIPLEY, JILL MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4362
Mailing Address - Country:US
Mailing Address - Phone:850-607-6910
Mailing Address - Fax:706-622-4486
Practice Address - Street 1:5900 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4362
Practice Address - Country:US
Practice Address - Phone:850-607-6910
Practice Address - Fax:706-622-4486
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22-215646106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician