Provider Demographics
NPI:1609837855
Name:HILL, LINDA L (PSYD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:HILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2656
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-6156
Mailing Address - Country:US
Mailing Address - Phone:219-763-6100
Mailing Address - Fax:
Practice Address - Street 1:3141 WILLOWCREEK RD
Practice Address - Street 2:SUITE F
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4468
Practice Address - Country:US
Practice Address - Phone:219-763-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041450A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7274667Medicare UPIN
IN000000386073Medicare UPIN
IN113471265165Medicare UPIN
IN828348000Medicare UPIN
IN266633Medicare UPIN