Provider Demographics
NPI:1629233564
Name:HILLMAN, LYNDA LOU (INDEPENDANT PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:LOU
Last Name:HILLMAN
Suffix:
Gender:F
Credentials:INDEPENDANT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 WESTBROOK ST SE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:OH
Mailing Address - Zip Code:44643-9745
Mailing Address - Country:US
Mailing Address - Phone:330-866-4377
Mailing Address - Fax:
Practice Address - Street 1:5631 WESTBROOK ST SE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:OH
Practice Address - Zip Code:44643-9745
Practice Address - Country:US
Practice Address - Phone:330-866-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2416424171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2416424Medicaid