Provider Demographics
NPI:1578733150
Name:POOR, HILLARY JANE (CSW)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:JANE
Last Name:POOR
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 SIDEWINDER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7258
Mailing Address - Country:US
Mailing Address - Phone:435-649-8347
Mailing Address - Fax:
Practice Address - Street 1:1753 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7258
Practice Address - Country:US
Practice Address - Phone:435-649-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT67527093502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker