Provider Demographics
NPI:1255649208
Name:BAILLIO, JILL N (PHD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:BAILLIO
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 1:2495 N DESERT LINKS DR APT 48
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3728
Mailing Address - Country:US
Mailing Address - Phone:813-294-0577
Mailing Address - Fax:305-768-0495
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-3652
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:305-768-0495
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8287103T00000X
NC3996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist