Provider Demographics
NPI:1417345067
Name:HILL, KIM (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22232 17TH AVE SE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7430
Mailing Address - Country:US
Mailing Address - Phone:425-487-3885
Mailing Address - Fax:425-487-4884
Practice Address - Street 1:22232 17TH AVE SE
Practice Address - Street 2:SUITE 312
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7430
Practice Address - Country:US
Practice Address - Phone:425-487-3885
Practice Address - Fax:425-487-4884
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 00001756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical