Provider Demographics
NPI:1609894070
Name:HILL, KERRIE JO (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:JO
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 1:939 OFFICE PARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2538
Mailing Address - Country:US
Mailing Address - Phone:515-226-2512
Mailing Address - Fax:515-440-3388
Practice Address - Street 1:939 OFFICE PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2538
Practice Address - Country:US
Practice Address - Phone:515-226-2512
Practice Address - Fax:515-440-3388
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014316Medicaid
IA44942OtherWELLMARK BLUE CROSS
IA42105384450265-A019OtherTRIWEST
IA238702OtherMIDLANDS CHOICE
IA0014316Medicaid