Provider Demographics
NPI:1497378160
Name:HILLAM, JESSICA ANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:HILLAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CORNIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1218 9TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-2207
Mailing Address - Country:US
Mailing Address - Phone:208-312-0957
Mailing Address - Fax:
Practice Address - Street 1:1218 9TH ST STE 2
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-2207
Practice Address - Country:US
Practice Address - Phone:208-312-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD4312231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist