Provider Demographics
NPI:1821455361
Name:JILL HARDEE
Entity Type:Organization
Organization Name:JILL HARDEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:907-598-3470
Mailing Address - Street 1:PO BOX 7501
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-7501
Mailing Address - Country:US
Mailing Address - Phone:907-598-3470
Mailing Address - Fax:
Practice Address - Street 1:43335 K BEACH RD BLDG E
Practice Address - Street 2:SUITE 8
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8280
Practice Address - Country:US
Practice Address - Phone:907-598-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1035251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health