Provider Demographics
NPI:1518971332
Name:HILL, EDWIN LAWRENCE (PHD LMT)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LAWRENCE
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 SOUTH 19TH
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2920
Mailing Address - Country:US
Mailing Address - Phone:253-383-3355
Mailing Address - Fax:253-383-3627
Practice Address - Street 1:2013 SO 19TH
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2920
Practice Address - Country:US
Practice Address - Phone:253-383-3355
Practice Address - Fax:253-383-3627
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000984103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0089341OtherDEPT OF L & I
WAHI9555OtherREGENCE BS
WAHI9555OtherREGENCE BS