Provider Demographics
NPI:1932492824
Name:HILL, STACY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 4TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5890
Mailing Address - Country:US
Mailing Address - Phone:208-746-2223
Mailing Address - Fax:208-746-2226
Practice Address - Street 1:3326 4TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5890
Practice Address - Country:US
Practice Address - Phone:208-746-2223
Practice Address - Fax:208-746-2226
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202575103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist