Provider Demographics
NPI:1679171961
Name:CHONODY, JILL MICHELLE
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MICHELLE
Last Name:CHONODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 S WATERBURY LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5222
Mailing Address - Country:US
Mailing Address - Phone:317-801-2682
Mailing Address - Fax:
Practice Address - Street 1:3134 S WATERBURY LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5222
Practice Address - Country:US
Practice Address - Phone:317-801-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID376051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical